SANITY  OF  MIND 

A  STUDY  OF  ITS  CONDITIONS,  AND  OF  THE 

MEANS  TO  ITS  DEVELOPMENT 

AND  PRESERVATION 


BY 
DAVID  F.  LINCOLN,  M.D. 

AUTHOR   OF   "SCHOOL  AND   INDUSTRIAL   HYGIENE,"    "HYGIENIC   PHYSIOLOGY, 
A  TEXT-BOOK  FOR  THE  USE  OF  SCHOOLS,"  BTC. 


SECOND  IMPRESSION 


G.  P.  PUTNAM'S  SONS 

NEW  YORK  AND  LONDON 

Gbe  ftnfcfcerbocfcer  press 

1901 


COPYRIGHT,  1900 

BY 
JAMES  MUNSON  BARNARD 


Ubc  ftnicfterbocftcr  press,  ftcw 


I 
1 


INTRODUCTORY   NOTE 

OQ 

T  is  fitting  to  express  my  most  sincere  acknow- 
ledgments  for  valuable  suggestions  received  from 
many  professional  friends  in  the  preparation  of  the 
^     following  pages.     I  cannot  attempt  to  name  all  who 
have  befriended  my  undertaking;  but  I  must  men- 
^     tion,  as  of  special  value,  the  help  received  from  Dr. 
-•     James  J.  Putnam  in  reading  and  criticising  the  manu- 
5]     script,  and  from  Dr.   Mary  Putnam  Jacobi  in  the 
same  service. 

D.  F.  LINCOLN. 

BOSTON,  June  i,  1900. 


CONTENTS 


CHAPTER  I 

PACK 

THE   OUTLOOK  .  .  .  »  »  .  .  I 

The  Attitude  of  the  Public  Mind  toward  Character  and 
Education  is  Favorable  to  Improved  Sanity  of  Mind. 

CHAPTER  II 

THE  NATURE  OF  MENTAL  DERANGEMENT  .  .  6 

Definitions,  8 — Classification,  9 — Border- Line  Conditions, 
13 — Pathology,  16 — Heredity,  18 — Tendency,  21 — Pros- 
pects in  Given  Cases,  22. 

CHAPTER  III 
DEGENERACY    .  .  .  .  .  .  .  .         28 

Definitions,  28 — Difference  in  Individual  Susceptibility, 
30 — Disorders  Allied  to  Insanity,  32 — Stigmata,  34 — 
Mental  Status  of  Criminals,  39 — Causes,  41 — Hospital 
Statistics  of  Causes,  47 — Civilization,  50. 

CHAPTER  IV 

EDUCATION -53 

Based  on  Study  of  Development,  54 — and  of  Neurotic 
Tendencies  of  Childhood,  58 — Bodily  Training,  69 — 
Regimen,  73 — The  Feeble-Minded,  77 — The  Backward, 
83 — Other  Defects,  85— Over-Study,  89— Child-Study, 
95 — Training  of  the  Active  Faculties,  100 — of  Observa- 
tion, 104 — of  Memory,  105 — of  Attention  and  Self-Con- 
trol,  107 — of  Judgment,  112 — Moral  Defects  in  Those 
Predisposed  to  Insanity,  115. 


vi  Contents 

PACK 

CHAPTER  V 
SELF-EDUCATION IlS 

The  Adults'  Point  of  View,  119 — Self-Control,  119 — 
Diet  and  Regimen,  121 — Influences  of  Solitude  and  of 
Self- Absorption,  126 — Necessity  of  Occupation  for  our 
Faculties,  130 — Advancing  Age,  135 — Low  Spirits,  136 — 
Mental  Influences  in  Controlling  Neuro-Psychic  Dis- 
orders, 138 — Progress  of  Humanity,  140. 

CHAPTER  VI 

OUR  SOCIAL  AND  CIVIC  DUTIES  .  145 

Increase  of  Insanity,  145 — The  Spartan  Remedy,  147 — 
Village  Asylums,  149 — Institutions  for  Early  Care  of  the 
Insane,  151 — and  for  After-Care,  154 — Epileptics,  155 — 
Custody  of  the  Feeble-Minded,  15'. — Surgical  Opera- 
tions, 161 — Restrictions  upon  the  Marriage  of  Defective 
Persons,  163. 

APPENDIX          .          .  ......      167 

INDEX 173 


SANITY  OF  MIND 


SANITY  OF  MIND 


CHAPTER  I 

THE  OUTLOOK 

Every  gift  of  noble  origin 
Is  breathed  upon  by  Hope's  perpetual  breath. 

Wordsworth,  Sonnets. 

A  SATISFACTORY,  workable  mind,  useful  to 
itself  and  its  neighbors,  on  which  one  relies  as 
upon  a  well  balanced  and  solidly  mounted  machine, 
|  is  the  product  of  an  inconceivably  complex  series  of 
causes,  remote  and  near.  Heredity  is  perhaps  the 
first  thing  that  occurs  to  our  mind  when  the  cause 
of  its  good  or  bad  quality  is  asked  for.  The  influ- 
ence of  ancestry  is  a  profound  problem  ;  and  it  must 
be  confessed  that  this  influence  seems  more  mys- 
terious, its  ramifications  more  extraordinary  and 
more  nearly  universal,  in  proportion  to  our  study 
of  it. 

Intermingled  with  inherited  traits  there  are  a 
hundred  accidents  and  stresses  in  daily  life  which 
put  the  workmanship  of  the  machinery  to  the  test, 
and  often  derange  it.  The  problem,  whether  the 


2  Sanity  of  Mind 

accident  or  the  weakness  of  the  original  construction 
has  most  to  do  with  the  calamity,  is  an  ever-present 
one,  not  to  be  solved  by  generalizations. 

Children  cannot  choose  their  own  ancestry,  but 
the  public  may  decree  that  fewer  worthless  children 
shall  be  born  of  mindless  parents.^  Public  duties  to 
children  begin  before  their  birth.  And  when  born, 
the  duty  of  guiding  their  education  commences  at 
once.  Childhood  offers  possibilities  in  the  way  of 
education  for  sanity  that  are  little  appreciated.  Our 
very  conception  of  what  elementary  education  means 
will  have  to  be  revolutionized  before  these  oppor- 
tunities are  fully  grasped. 

The  possibilities  of  improvement  are  greater,  I 
think,  than  the  public  suspect.  There  is  compara- 
tively little  to  be  done  for  middle  life  with  its 
.  confirmed  habits  —  there  is  an  indefinite  field  for 
improvement  among  the  young.  There  are  public 
duties  in  this  direction  not  yet  attended  to,  which 
offer  reasonable  promise  of  large  diminutions  in 
crime  and  insanity;  of  which  more  hereafter. 

I  think  myself  warranted  in  saying  that  we  have 
a  right  to  a  certain  optimism  in  regard  to  the  effects 
of  the  laws  of  heredity  and  of  training,  as  a  whole. 
There  has  been  a  change,  too,  in  public  feeling  in 
these  matters./  Where  there  once  was  an  over- 
powering sense  of  the  unfailing  and  all-sufficing 
causality  of  what  was  called  Law ;  of  the  absolute 
dependence  of  phenomena  of  all  sorts,  including 
the  supreme  one  of  Will,  upon  visible,  tangible, 
material  elements  in  the  physical  body  and  its 


The  Outlook  3 

activities,  there  is  now  a  growing  consciousness  of 
self-activity  and  freedom.  Where  there  was  a  stern 
sense  of  evil  remorselessly  foisted  on  ^posterity,  of 
dire  heritages  of  the  effects  of  vice  and  sickness, 
there  is  now  recognition  of  the  tendency  in  things 
to  spontaneous  improvement.  The  ruin  of  the  first 
generation  is  balanced  by  possibilities  of  redemption 
and  the  disappearance  of  taint.  Pessimism  as  a 
philosophy  has  not  the  vogue  it  had  yesterday.  In 
anthropology,  we  are  reacting  vigorously  against 
the  terrible  doctrine  of  the  Italian  school,  which  sets 
up  "  the  criminal  man  "  as  a  kind  of  race  or  type 
per  se,  predestined  to  vice  by  their  very  form  and 
features.  ( We  are  learning  to  place  the  blame  of 
criminality,  for  the  most  part,  upon  Society  rather 
than  Nature.^) 

All  these  are  examples  of  a  general  tendency  of  j  | 
our  time.  /  We  are  dwelling  on  the  value  of  the  Will 
and  its  freedom,  as  a  basis  of  character.'  We  are  ' 
tired  of  the  dictum  which  seemed  so  refreshing  to 
the  past  generation,  "  No  thinking  without  phos- 
phorus "  (a  most  imperfect  statement  at  best),  and 
of  its  twin  brother,  "  The  brain  secretes  thought  as 
the  liver  secretes  bile."  It  is  well  to  have  been 
through  these  stages  of  thought,  and  to  have  learnt 
their  lesson  of  the  importance  of  food  and  the  other 
physical  bases  of  life.  Having  fully  accepted  and 
assimilated  certain  practical  inferences  from  these 
points  of  view,  we  are  now  inclined  to  give  more 
attention  to  the  converse  truth,  and  to  examine  the 
ways  in  which  Mind  rules  Body. 


4  Sanity  of  Mind 

We  are,  in  fact,  beginning  to  be  prepared  to  see 
both  sides  of  the  problem ;  body  and  mind  in  a 
mutual  subordination  and  dependence.  In  gymnas- 
tics, in  physical  training,  we  are  learning  to  look  on 
the  nerve  and  the  muscle  as  one  compound  organ, 
a  mutual  copartnership,  filling  the  place  of  gover- 
nors and  employees  of  the  other  organs. 

'In  education,  the  new  advances  are  inspired  by 
belief   in   the  value  of  self-originated  activity  and 
self-government  on  the  part  of  the  pupils.     The 
attitude  of  mental  submission  and  passive  acquire- 
ment is  no  longer  the  ideal.     It  begins  to  dawn  on 
us  that  submissiveness  to  authority  is  a  valueless 
trait,  unless  it  be  the  fruit  of  a  well  balanced  judg- 
ment and  an  independent  will;  and  the  confirmation  \ 
got  by  reformative  appeals  to  this  side  of  the  nature  ' 
is  amazing. 

Even  the  so-called  "  parental  relation,"  attractive 
as  the  phrase  sounds,  has  in  it  of  necessity  the  ele- 
ment of  arbitrary  force,  and  to  some  extent  may 
place  the  authorities  and  pupils  of  reform-schools  in 
a  condition  of  mutual  resistance. 

In  the  words  of  Nicholas  Murray  Butler,  "  Spon- 
taneity is  the  key-note  of  education  in  the  United 
States."  Self-development  through  self-govern- 
ment, of  which  the  "  George  Junior  Republic  "  at 
present  offers  the  most  notable  type,  is  no  longer 
an  academic  phrase,  but  a  practical  element  in  pro- 
gressive pedagogy  and  reformatory  work. 

The  attitude  of  parents  toward  children  is  less 
satisfactory.  \We  still  make  them  our  dolls,  and 


The  Outlook  5 

enjoy  them  as  we  do  bon-bons.  Some  sentimental- 
ize over  them ;  some  snub  them ;  many  find  them 
de  trop,  and  few  understand  the  principle  of  equality 
in  treating  them.  (  And  yet,  of  all  reforms  and  en- 
lightenments, those  are  the  most  promising  which 
have  to  do  with  children.  ;  And  if  few  men  can  be 
found  who  will  sacrifice  their  own  pleasure,  there  is 
satisfaction  in  knowing,  among  the  few,  those  whose 
broad  humanity  and  power  of  leadership  shame  the 
rest  of  us  into  enthusiasm. 

Upon  the  grown  man  and  woman  is  laid  that 
hardest  of  tasks,  to  know  themselves — to  govern 
themselves.  There  are  a  certain  few  who  sincerely 
attempt  this;  some,  even,  in  the  interest  of  their 
own  mental  health,  and  in  the  hope  of  avoiding 
threatened  insanity.  If  I  can  find  anything  helpful 
to  say  to  such,  it  will  be  very  grateful  to  me. 

And  finally,  we  have  as  citizens,  acting  through 
the  power  of  the  State,  powers  not  yet  exercised, 
which  have  a  reasonable  promise  of  relieving  to  a 
large  extent  the  burden  of  criminality,  and  to  a  very 
perceptible  extent  the  scourge  of  insanity.  I  will 
not  anticipate  these  conclusions,  which  form  the 
closing  chapter  of  this  book. 


CHAPTER  II 

THE  NATURE  OF  MENTAL  DERANGEMENT 

Mad  let  us  grant  him  then  :  and  now  remains 
That  we  find  out  the  cause  of  this  effect ; 
Or  rather  say,  the  cause  of  this  defect ; 
For  this  effect,  defective,  comes  by  cause. 

Hamlet,  ii.,  2. 

THERE  is  something  in  the  mental  attitude  of 
our  day  which  makes  it  easier  to  discuss  the 
problems  before  us  than  it  was  a  hundred  years  ago. 
We  have  outlived  the  period  of  metaphysical  analysis 
and  classification  —  we  have  got  beyond  the  notion 
of  "  mind  disease,"  as  something  possibly  originat- 
ing in  sinfulness,  perhaps  based  on  demoniac  influ- 
ence, but  at  all  events  originating  in  the  spiritual 
part,  and  punishable  by  means  suited  to  the  correc- 
tion of  contumacy  and  evil-mindedness.  We  have 
come  to  see  (or  we  begin  to  see)  the  inadequacy  of 
those  really  materialistic  views  to  which  psychiatry 
has  devoted  itself  for  fifty  years  past,  and  are,  with 
more  or  less  of  variancy,  on  the  road  to  acknow- 
ledgment of  the  potency  of  mental  influences.  We 
have  begun  to  feel  that  asylum-treatment  is  not  the 
last  word  of  science;  and  the  notion  that  "  a  man  's 
a  man  for  a'  that,"  whether  sane  or  insane,  now 

6 


Nature  of  Mental  Derangement       7 

suggests  to  us  many  points  in  which  we  had  syste- 
matically overlooked  the  very  humanity  of  our  sick 
brethren.,  We  also  begin  to  study  insanity,  not 
merely  as  philanthropists,  but  from  the  point  of 
view  of  husbanding  the  State's  resources  and  of 
extinguishing  the  evil  by  practical  legislation.  More 
general  in  its  influence  is  the  attitude  taken  by  large 
numbers  in  regard  to  the  connection  of  mind  and 
body.  The  study  of  psychology  with  laboratory  in- 
struments and  methods  has  linked  thought  and  mat- 
ter in  a  wondrously  impressive  way,  and  it  may  even 
be  said  that  a  kind  of  monism  is  popularly  held  —  a 
view  which  clamps,  if  it  does  not  weld  together,  the 
two  entities  once  called  Mind  and  Matter,  and  now 
unified  under  the  inadequate  designation  of  Mind. 

Whatever  may  come  of  the  latter  tendency,  it 
certainly  needs  to  be  broadened  by  practical  study 
of  education,  criminology,  and  sociology,  of  the 
laws  of  human  development  and  of  degeneracy,  of 
the  physiology  of  the  mind,  and  of  disease  in  gen- 
eral. In  so  far  as  any  new  sect  binds  itself  to  one 
sole  line  of  study,  it  fails  to  grasp  the  fact  of  the 
unity  of  all  man's  manifestations — which  is  the  key 
to  the  problems  before  us. 

As  all  the  elements  of  the  soil  are  brought  to  sight 
in  the  crops  and  fruits,  so  all  the  basal  faculties  of 
man  are  the  feeders  of  his  intellectual  and  moral 
life.  His  social  relations  are  his  morality ;  his  ex- 
ertions are  his  intellectual  activities  in  esse.  No 
minor  generalization  will  take  in  the  subject;  we 
are  studying  nothing  less  than  Man's  Life. 


8  Sanity  of  Mind 

A  satisfactory  definition  of  insanity,  it  is  said,  has 
never  been  given.  The  subject  is  in  fact  so  broad 
that  any  attempt  to  cover  it  in  all  its  bearings  results 
either  in  obscurity  or  in  extreme  generalization. 
An  infallible  definition,  however,  is  not  what  we 
need ;  for  the  present  purpose  it  suffices  to  present 
the  leading  points  of  the  conception  clearly  and  in 
conformity  with  the  ordinary  usage  of  medicine, 
law,  and  social  life. 

Maudsley's  definition  includes  the  important  fact 
that  disturbance  of  the  judgment  or  reason  is  not 
the  one  essential  feature  of  this  disorder,  since  it 
may  involve  either  the  region  of  feeling,  or  that  of 
ideation,  or  that  of  conduct,  or  two,  or  all  of  these. 
He  adds  that  it  more  or  less  incapacitates  the 
individual  for  his  due  social  relations.  Mercier's 
concentrated  definition,1  "  a  defective  psychic  ad- 
justment of  the  organism  to  its  environment,"  sug- 
gests the  same  fact,  and  reminds  us  of  the  prevailing 
unsocial  or  selfish  nature  of  insanity. 

To  include  mental  defect,  or  arrest  of  develop- 
ment, as  in  idiocy  and  feeble-mindedness,  carries  us 
beyond  the  popular  conception  of  insanity ;  but  we 
must  logically  make  the  inclusion.  In  fact,  we 
can  have  no  clear  idea  of  the  origin  of  insanity 
unless  we  include  mental  defects  of  all  kinds  in 
our  view. 

Among  the  points  which  legal  logic  has  formerly 
insisted  upon  is  the  notion  that  the  insane  are 
strictly  set  apart  from  the  sane  by  an  inability  to 

1  After  Herbert  Spencer. 


Nature  of  Mental  Derangement       9 

judge  of  right  and  wrong.  This  is  very  misleading. 
In  the  case  of  irresistible  impulse,  there  is  often  a 
clear  perception  of  the  wrong  nature  of  the  act,  and 
even  a  horror  of  it.  And  again,  a  man  may  have 
good  moral  notions,  but  may  be  possessed  with  the 
delusion  that  some  one  is  threatening  his  life,  and 
may  act  in  a  desperate  way  under  this  belief. 

Neither  are  the  insane  always  irresponsible.  In 
many  cases  they  deserve  credit  for  kind  or  honest 
acts  and  blame  for  malice  and  treachery,  in  the  same 
sense  in  which  the  rest  of  us  do.  In  asylums,  the 
efficacy  of  certain  distinctions  and  deprivations  of 
privilege  in  aid  of  discipline,  indicates  that  the  in- 
sane are  largely  amenable  to  the  same  motives  and 
controlled  by  the  same  methods  as  the  sane.  Mer- 
cier  tells  the  story  of  a  patient  who,  in  the  absence 
of  ward  tenders,  used  to  vent  his  low,  bullying  pro- 
pensities upon  his  helpless  neighbors  by  giving  them 
a  black  eye  now  and  then.  One  day  a  small,  quiet 
patient  was  introduced.  The  next  morning  our 
bully  was  found  very  badly  knocked  up;  he  had 
tried  his  usual  trick  on  the  new  man,  who  happened 
to  be  a  prize-fighter  by  trade,  and  who  administered 
a  dose  which  proved  a  permanent  cure. 

The  inadequacy  of  all  attempts  at  definition  comes 
out  clearly  when  we  try  to  decide  whether  anger  is 
a  form  of  insanity  or  not ;  we  leave  the  problem  to 
the  reader's  decision. 

The  systems  of  classification  under  which  the  dif- 
ferent forms  of  insanity  are  grouped  are  many  and 


io  Sanity  of  Mind 

various.  This  variation  is  in  part  a  matter  of  in- 
dividual taste,  or  point  of  view,  and  in  part  it 
expresses  the  imperfection  of  the  theory  of  insanity. 
Without  offering  any  complete  system,  I  think  it 
will  be  helpful  here  to  notice  some  of  the  chief  forms 
of  disorder. 

Mania  and  melancholia  almost  explain  themselves. 
The  former  is  a  state  of  increased  flow  and  dis- 
play of  bodily  and  mental  performance;  with  ex- 
citement, and  generally  incoherence.  The  latter 
presents  retarded  and  checked  activities,  men- 
tal and  physical,  with  depression  ;  the  patient 
is  sad,  despondent,  even  crushed,  dazed,  or  stu- 
pefied ;  or  sometimes  agitated  in  the  midst  of  the 
depression. 

These  terms  are  sanctioned  by  the  usage  of  an- 
tiquity. They  form  the  corner-stone  of  most 
systematic  classifications  of  insanity,  and  as  they 
represent  common  and  palpable  phenomena,  it  is 
important  to  know  them.  But  there  is  great 
probability  that  they  do  not  represent  distinct 
diseases,  or  "  morbid  entities,"  in  the  sense  in 
which  measles  or  rheumatism  are  distinct.  They 
are,  indeed,  very  often  combined  with  or  run  into 
each  other. 

Dementia  is  a  loss  of  mental  power.  It  may  fol- 
low an  attack  of  acute  mania  or  melancholia,  or  may 
come  on  independently.  There  is  a  special  form 
called  paralytic  dementia,  or  paresis,  which  belongs 
chiefly  to  the  latter  half  of  life. 

Hypochondria  is  a  melancholic  state  in  which  the 


Nature  of  Mental  Derangement     1 1 

sufferer  is  much  occupied  with  personal  sensations 
and  false  notions  about  the  state  of  his  body. 

Paranoia  (monomania)  is  a  state  in  which  certain 
fixed  notions  and  opinions,  based  on  delusion,  en- 
gross and  strongly  control  the  mind  and  pervert  the 
judgment. 

One  of  the  latest  inductions,  offered  on  the  high 
authority  of  Kraepelin,  affirms  the  existence  of  an 
important  class  of  disease  termed  "  manic-depres- 
sive insanity,"  a  compound  of  mania  and  melancholia 
in  alternation,  often  with  intervals  of  sanity ;  under 
which  designation  it  is  found  that  a  very  consider- 
able proportion  of  cases  can  be  brought.  If  we 
accept  this  view,  it  leads  us  to  the  conception  that 
the  real  disease  is  something  underlying,  which 
has  escaped  our  analysis,  while  the  effervescence  of 
mania  and  the  leaden  grief  of  melancholia  are  but 
symptoms — parts  of  one  and  the  same  picture,  like 
the  cold  and  the  hot  stages  of  ague. 

In  dividing  natural  objects  into  classes,  the 
naturalist  has  in  view,  at  the  first,  convenience  in 
naming  them  and  the  advantages  which  accrue  from 
having  some  name,  however  arbitrary.  Later  in 
the  development  of  a  science  comes  the  desire  of  a 
nomenclature  which  expresses  the  basal  principles 
upon  which  the  differences  of  species  are  founded. 
And  so  it  is  beginning  to  be  with  insanity.  It  is  felt 
that  present  systems  of  classification  are  mostly 
based  on  external  facts,  upon  leading  symptoms 
which  may  or  may  not  be  essential  and  basal  in  their 
nature. 


12  Sanity  of  Mind 

In  addition  to  manic-depressive  insanity  (now 
widely  recognized  by  specialists),  Kraepelin  has  pro- 
posed some  other  rearrangements  of  groups,  of 
which  I  will  only  briefly  mention  "  dementia  prae- 
cox,"  characterized  by  a  tendency  to  sink  into  im. 
becility.  The  reader  will  understand,  however,  that 
the  plan  of  this  book  does  not  permit  the  discussion 
of  the  correctness  of  this  scheme.  Kraepelin's 
merit  consists  in  having  seen  that  the  old  classifica- 
tions were  superficial  —  based  on  outward,  often 
changeable,  appearances  rather  than  on  essential 
similarity  of  nature.  \  He  initiated  an  effort,  which 
is  still  being  carried  forward,  to  base  the  character 
of  the  disease  upon  all  its  symptoms,  through  its 
entire  course,  however  long-continued.  He  has 
endeavored  to  set  apart  the  curable  from  the  incur- 
able forms;  those  tending  to  recovery  from  those 
whose  natural  exit  (ausgang*}  is  in  dementia.  This 
admirable  attempt  is  being  paralleled  by  the  ad- 
vances in  knowledge  of  the  morbid  anatomy  of  the 
brain  and  spinal  cord,  as  bearing  upon  insanity, 
which  have  characterized  the  scientific  history  of 
the  past  ten  years. 

A  useful  and  suggestive  grouping  of  the  forms  of 
insanity  may  be  made  as  follows.  First,  there  are 
several  classes  which  tend  to  dementia  —  the  essen- 
tially degenerative  forms  of  insanity ;  among  which 
are  found  paresis  and  the  dementia  of  old  age,  which 
display  very  marked  anatomical  lesions  of  nerve  ele- 
ments, besides  other  important  forms  the  pathology 
of  which  is  less  distinctly  made  out.  Second,  there 


Nature  of  Mental  Derangement     13 

are  those  disorders  which  do  not  specially  tend  to 
grave  dementia,  although  chronic  in  their  habit; 
including  paranoia  (monomania),  and  the  insanity 
of  the  change  of  life.  Third,  the  acute  psychoses: 
simple  melancholia,  manic-depressive  insanity,  and 
confusional  insanity,  which  tend  to  recovery,  and 
may  relapse. 

To  these  necessarily  imperfect  and  cursory  re- 
marks on  classifying  positive  insanity,  it  will  be  well 
to  add  some  description  of  certain  affections  and 
conditions  which  lie  on  the  border  line  between 
morbidity  and  insanity.  To  the  eye  of  the  student 
of  causes  these  states  are  only  less  fully  developed 
products  of  the  conditions  producing  madness, 
namely,  a  constitution  more  or  less  deteriorated 
or  degenerate.  The  types  of  the  class  referred 
to  are  epilepsy,  hysteria,  certain  morbid  feelings 
and  impulses,  and  congenital  neurasthenia  ;  in 
all  of  which  the  morbid  essence  is  something  in-  '•< 
nate,  something  wrong  in  the  constitution  of  the  ! 
sufferer. 

There  is  the  greatest  possible  range  in  the  devel- 
opment of  these  diseased  conditions.  At  one  ex- 
treme we  find  the  victims  of  impulsive  insanity  and 
epileptic  insanity  declared  irresponsible  by  the  law. 
At  the  other  end,  every  one  of  us  finds  himself 
sometimes  losing  self-control  under  stress  of  toil 
and  care.  And  between,  there  is  what  is  called 
the  "  insane  temperament,"  characteristic  of  many 
persons  never  known  to  have  been  actually  in- 


14  Sanity  of  Mind 

sane,  and  of  many  who  do  go  mad — persons  termed 
"cranks"  by  their  afflicted  neighbors,  who  often 
find  it  hard  to  decide  on  which  side  of  the  line 
they  are.  It  is  common  enough  to  find  such  per- 
sons grouped  in  families,  following  the  biological 
law  of  degeneracy. 

One  of  the  characteristic  mental  troubles  which 
belong  to  this  group  of  morbid  constitutions  is  the 
haunting  presence  of  a  persistent  idea,  or  the  im- 
pulsion to  dwell  beyond  all  reason  on  certain  trains 
of  thought.  Here  also  belongs  the  picturesque 
group  of  morbid  fears,  or  "  phobias" — unreason- 
able, uncontrollable,  and  therefore  strictly  insane 
exaggerations  of  the  fears  to  which  all  are  liable. 
Such  are:  the  dread  of  crowds,  of  open  places,  of 
high  places;  dread  of  certain  forms  of  sickness; 
dread  of  contact  with  dirt,  actual  or  potential, 
and  of  possible  contagion  through  such  contact; 
dread  of  making  erroneous  statements,  of  appro- 
priating others'  goods,  of  saying  unseemly  things, 
of  blushing;  of  pass  examinations  —  in  short,  of  all 
things  imaginable,  the  most  ordinary  and  the  most 
bizarre. 

Impulses  to  eccentric  or  criminal  acts  without 
motive  need  no  special  discussion  here,  beyond 
noting  that  they  often  make  their  appearance  during 
adolescence,  when  they  may  be  favorably  influenced, 
if  ever,  by  education. 

Constitutional  depression  of  spirits  is  admittedly 
a  "  morbid,"  that  is,  a  diseased  state,  yet  cannot 
be  called  insanity.  Its  victims  as  a  class  lack  en- 


Nature  of  Mental  Derangement     15 

durance  and  are  easily  fatigued,  and  suffer  much 
from  headache,  loss  of  sleep,  indigestion,  and 
other  nervous  symptoms.  Some  by  persevering 
accomplish  good  work,  but  as  a  rule  the  lack  of 
courage,  the  feeling  that  something  is  "out" 
with  them,  an  overstrained  conscience,  an  absence 
of  satisfaction  in  existence,  are  perpetual  hind- 
rances to  success. 

It  is  important  to  distinguish  such  cases  from 
others  in  which  very  similar  signs  of  mental  depres- 
sion and  disturbance  exist,  but  are  due  to  chronic 
nervous  exhaustion  from  overwork  and  other  causes. 
/  In  the  latter  the  nervous  symptoms  disappear  when 
the  tension  is  removed./  Sometimes  it  is  relief  from 
mere  fatigue  that  is  required ;  at  other  times  a 
mental  or  emotional  state  must  be  delicately  read- 
justed and  a  new  motive  or  hope  induced.  The 
possibility  of  relief  by  rest,  recreation,  and  removal 
of  injurious  agencies  is  characteristic  of  pure  ac- 
quired neurasthenia.  The  constitutional  form  is 
not  so  relieved,  and  appears  to  offer  small  hope  of 
cure,  while  there  exists  a  possibility  (doubtless  a 
remote  and  very  rare  one)  of  a  transition  to  fully 
developed  insanity. 

But  it  seems  probable  that  the  constitutional 
element  is  seldom  entirely  absent  from  neuras- 
thenia, though  the  amount  present  may  vary  to  any 
extent.  The  question  of  amount  is  of  course  im- 
portant to  the  patient.  As  regards  the  development 
of  insanity  from  neurasthenia  by  family  descent,  it 
is  quite  doubtful. 


1 6  Sanity  of  Mind 

It  was  formerly  assumed  that  all  insanity  rested 
on  the  basis  of  diseased  states  of  the  brain.  The 
proof  has  never  yet  been  rendered  in  its  entirety. 
Pathological-anatomical  changes  have  been  made 
out  in  paresis,  in  senile  dementia,  alcoholism ;  prob- 
ably in  epilepsy  and  dementia  praecox  and  climacteric 
insanity.  This  list  leaves  out  a  considerable  part  of 
the  acknowledged  field  of  insanity ;  but  progress  in 
covering  the  field  is  still  making.  There  are  many 
abnormal  states  of  the  brain  cells  detected  by  the 
microscope,  but  not  so  definitely  as  to  enable  us, 
from  inspection  of  the  brain,  to  decide  upon  the 
nature  of  the  mental  symptoms  observed  during 
life. 

The  veil  is  indeed  over  much  of  the  field  of  view, 
and  a  correlation  between  the  mental  symptoms  and 
the  pathological  anatomy  is  as  yet  largely  to  be 
made  out.  But  the  substantial,  general  relation  be- 
tween injury  of  brain  and  derangement  of  mind  is  a 
broad  fact,  and  stares  us  in  the  face.  That  a  bullet 
traversing  the  brain  is  the  primary  causal  element  in 
the  subsequent  mental  disturbance  of  the  wounded 
man;  that  the  wasting  and  shrinking  processes  of 
age,  affecting  brain  and  muscle  alike,  or  the  poison 
generated  by  fevers,  or  the  poison  introduced  in  the 
form  of  alcohol  or  opium,  act  equally  as  causes,  are 
propositions  which  it  is  unnecessary  to  defend. 

There  remains,  however,  the  necessity  of  discrim- 
inating between  cases  of  permanent  injury  to  the 
tissues,  and  cases  in  which  a  seemingly  complete 
recovery  allows  us  to  hope  that  the  tissues  have  re- 


Nature  of  Mental  Derangement     1 7 

turned  to  a  state  of  health.  The  former  are  organic, 
the  latter  functional,  diseases. 

Granting  that  the  diseased  condition  is  entirely 
cured,  without  residual  signs, — there  is  propriety, 
even  then,  in  retaining  the  idea  of  physical  disease, 
a  morbid  disturbance  of  physical  states.  A  state- 
ment that  the  patient's  frenzy  or  stupor  or  suspicion 
are  phases  of  disorder  of  mental,  affective,  or  motor 
processes,  might  have  satisfied  the  predecessors  of 
Pinel,  but  is  not  helpful  to  us,  holding  as  we  do  the 
belief  that  mental  disturbance  and  brain  disturbance 
are  inseparable  facts,  and  divergent  phases  of  one  and 
the  same  event.  And  what  idea  may  we  rationally 
entertain  of  the  physical  side  of  such  a  process  ? 

It  is  a  good  and  reasonable  generalization  from 
our  knowledge  to  suppose  that  changes  in  the  nutri- 
tion of  the  brain-elements,  or  "  neurons,"  of  varying 
degree  and  kind,  form  the  basis  of  such  mental 
disturbances.  By  nutritional  disorder,  we  must 
understand  not  only  that  too  much,  too  little,  or 
chemically  insufficient  food-stuff  is  carried  to  the 
brain ;  but  that,  in  addition  to  these  derangements, 
the  brain  is  sometimes  poisoned  by  alcoholic  and 
other  foreign  materials,  or  by  the  presence  in  the 
blood  of  effete  substances  which  ought  to  be  swept 
out  through  the  kidneys,  the  lungs,  or  the  skin.  And 
we  may  also  understand  that  the  cell-tissue  of  the 
brain  may  become  exhausted  by  over-stimulation 
until  it  ceases  to  appropriate  nourishment  from  the 
blood;  or  that,  through  inherent  want  of  vigor,  it 
shows  inaptitude  in  the  rapid  and  complete  assimi- 


1 8  Sanity  of  Mind 

lation  of  new  nutriment,  j  If  the  idea  is  taken  in 
this  broad  sense,  we  may  fairly  say  that  malnutri- 
tion of  nerve -tissue  lies  at  the  basis  of  all  mental 
disorder.  \ 

It  is  in  an  important  sense  true,  that  the  man  in- 
herits from  the  boy.  A  continuity  of  life,  of  tissues, 
of  habits,  undeniably  bridges  over  the  passage  from 
childhood  to  manhood.  The  cells  actually  compos- 
ing a  body  are  either  the  identical  cells  with  which 
it  was  born,  or  newer  cells  directly  formed  from 
these  and  standing  in  a  filial  relation  to  them,  so 
that  the  individual  components  of  our  bodies  at  any 
period  are  direct  descendants  of  those  with  which 
we  were  born.  The  continuity  of  life,  which  is  so 
plain  when  we  study  the  budding  plant-cell,  becom- 
ing two  where  there  was  but  one  before,  extends 
through  our  own  organism  and  our  own  lifetime  in 
like  manner. 

The  processes  of  parentage  and  birth  involve  the 
same  idea  of  cell  giving  rise  to  cell,  that  we  have 
just  stated  in  relation  to  ordinary  life.  The  act  of 
fecundation,  or  the  union  of  two  cells,  representing 
two  parents,  is  followed  by  manifold  subdivision 
into  new  cells  in  continuity  of  life.  As  Clouston 
puts  it,  "  Heredity  is  best  understood  as  continuity 
of  cell-life." 

Potencies  which  we  cannot  see  inhere  in  the  cells, 
and  are  transferred  in  connection  with  them ;  from 
parent  animal  to  its  offspring,  and  from  mother  cell 
to  its  daughter  cell.  We  study  the  cell  by  the  eye ; 


Nature  of  Mental  Derangement     19 

we  study  its  potencies  by  observing  health,  disease, 
and  "  human  nature,"  partly  in  the  minute,  but 
mostly  in  the  gross. 

The  natural  history  of  disease  may  be  invoked 
as  furnishing  illustrations  of  this  transmission  of  im- 
pressions, either  occurring  within  the  lifetime  of  an 
individual,  or  involving  a  parent  and  its  offspring. 

Diseases  differ  widely  in  this  respect.  Some  (as 
typhoid  fever  or  grippe)  are  so  independent  that  a 
first  attack  does  not  involve  any  prospect  of  a 
second.  Others  (as  rheumatism,  gout,  epilepsy) 
seem  often  to  imprint  a  stamp  upon  the  organism, 
so  that  the  first  attack  leaves  one  distinctly  more 
liable  to  have  subsequent  attacks.  And  the  con- 
stitutional impression  is  transmissible,  under  limita- 
tions, to  offspring.  Insanity  belongs  to  the  second 
class ;  in  most  cases  one  is  more  liable  to  a  recurrence 
of  the  disorder  after  a  first  attack.  Fortunately, 
this  is  not  true  in  all  cases,  especially  in  the  young 
and  vigorous. 

[  The  true  cause  of  the  disease  is  the  original  cause  ;\  J 
hence  heredity  is  not  strictly  a  cause,  but  a  means 
of  transmitting  insanity.     Heredity  is  a  character, 
a  trait,  of  the  disorder. 

Let  me  illustrate  this  statement  a  little  further,  to 
prevent  misunderstanding.  It  is  right  to  say,  as  we 
commonly  do,  "  A  is  insane  because  his  father  was; 
he  inherits  it."  Test  the  matter  in  the  negative 
form ;  it  is  a  principle  of  logic  that  removal  of  cause 
will  remove  the  effect,  and  so  we  may  say  that  "  if 
A's  father,  or  his  progenitors,  had  not  been  drunk- 


20  Sanity  of  Mind 

ards,  A  would  not  have  been  the  nervous  wreck 
that  he  is."  In  such  a  sense  inheritance  is  a  cause 
of  many  cases  of  insanity.  But  if  by  cause  we  mean 
origin,  then  we  cannot  be  satisfied  with  "  heredity  " 
alone.  Both  views  are  important.  It  is  important 
to  trace  a  train  of  consequences ;  it  is  at  least  equally 
so  to  ascertain  the  original  fact  which  first  set  the 
consequences  in  motion.  In  a  certain  point  of  view, 
it  is  more  useful /to  know  the  first  cause.  The  time 
for  prevention  is  before  the  first  cause  has  rooted 
itself  in  a  man's  nature.  And  again,  a  first  cause 
may  be  simple,  while  inherited  effects  are  strangely 
varied.  Still  again,  it  is  of  the  utmost  importance 
to  remember  that  the  causes  are  not  wholly  wrapt 
in  the  mystery  which  "heredity"  suggests;  for 
there  are  thousands  of  cases  occurring  every  year 
which  spring  up,  as  it  were,  in  fresh  soil,  in  untainted 
families,  under  the  influence  of  new  and  obvious 
causes.  The  total  number  of  the  insane  would 
rapidly  diminish  under  the  process  of  natural  ex- 
tinction, if  it  were  not  that  fresh  contingents  are 
constantly  added  from  those  whose  power  of  resist- 
ance proves  too  weak  to  stand  the  many  stresses  of 
life  and  the  many  poisons  which  civilized  existence 
infects  us  with. 

The  inheritance  of  disease  is  no  greater  mystery 
than  that  of  health.  The  normal  child  is  born  with 
a  life  destiny,  an  endowment  of  capacities  and  latent 
tendencies  which  will  make  him  at  first  a  feeder  and 
grower,  next  a  sexual  being,  to  culminate  at  a  given 
age,  and  then  to  decline  in  age  with  a  series  of  in- 


Nature  of  Mental  Derangement     2 1 

volutions  as  wonderful  as  those  we  call  development. 
The  child  of  unsound  parentage  may  be  beautiful  ' 
and  strong  till  his  twentieth  or  his  fortieth  year, 
carrying  all  the  while  a  perfectly  concealed  tend- 
ency; at  a  given  time  he  has  gout  or  insanity,  or 
some  other  predestined  affliction.  It  reminds  one 
of  a  mine  set  to  go  off  with  a  time-fuse. 

It  will  be  seen  from  this  that  we  are  not  to  sup- 
pose that  insanity  or  gout  per  se  is  inherited.  What 
we  inherit  is  rather  a  susceptibility  or  a  tendency  to 
these  disorders — not  the  disorders  themselves.  We 
are  given  a  body  which,  if  things  take  their  natural 
course,  is  likely  to  give  rise  to  these  troubles.  Who 
shall  tell  us  in  advance  ?  The  mine  is  there;  can 
we  not  find  the  fuse  and  cut  it  ?  Can  we  do  nothing 
to  arrest  tendencies  ?  The  question  is  of  momentous 
importance,  and  is  felt  as  such,  with  painful  weight, 
by  some  of  us.  A  partially  affirmative  answer  will 
be  given  in  some  of  the  later  chapters  of  this  book, 
with  a  consideration  of  the  methods  of  education 
and  living  appropriate  to  such  prevention. 

One  of  our  most  prominent  specialists  in  insanity,1 
and,  I  venture  to  add,  one  of  the  fairest-minded, 
has  expressed  himself  to  me  in  conversation  to  the 
effect  that  the  fatal  necessity  of  insane  entailment 
has  been  greatly  exaggerated,  and  forms  a  great 
popular  error.  What  is  inherited  is  tendency. 

I  know  of  persons  [he  said]  of  tuberculous  inheritance, 
who  have  escaped  by  correct  living  though  other  mem- 
bers of  the  family  have  died  of  it.     Tubercle  is  one  of 
1  Dr.  Hurd,  Superintendent  Johns  Hopkins  Hospital. 


22  Sanity  of  Mind 

the  very  strong  predispositions;  we  can  escape  it;  and 
if  so,  I  see  no  reason  why  we  cannot  escape  the  insane 
predisposition  by  a  similar  life  of  precaution.  In  some 
forms  of  insanity  the  ability  to  prevent  a  second  attack 
lies  greatly  in  the  power  of  the  patient. 

There  is  no  doubt  that  erroneous,  and  in  part  ex- 
aggerated, views  prevail  in  regard  to  the  heredity 
of  insanity.  A  great  many  persons  find  it  easiest  to 
ignore  the  whole  matter  of  heredity,  to  deny  or  ex- 
tenuate its  occurrence  in  their  own  families,  and  to 
promote  or  contract  marriages  in  most  unpromising 
cases  or  even  to  cause  the  marriage  of  an  actually 
insane  person.  There  are  others,  not  a  few,  who 
allow  themselves  to  be  influenced  by  an  ignorant 
dread  of  the  unknown,  without  asking  for  the  coun- 
sel of  those  who  are  better  informed.  I  venture  to 
present  a  few  points  in  illustration  of  what  I  con- 
ceive to  be  the  true  ground  to  hold. 

i.  A  great  many  cases  of  insanity  are,  as  far  as 
very  careful  examination  shows,' 'without  heredity." 
The  number  in  which  insanity  in  near  relatives  can 
be  shown  to  exist  is  rather  surprisingly  small — prob- 
ably amounting  to  a  fifth  or  a  quarter  of  all  cases; 
and  if  we  double  this  to  allow  for  imperfect  data, 
we  still  have  remaining  a  great  number  of  cases  in 
which  insanity  is  probably  original  with  the  patient. 
When  a  careful  tracing  of  family  history  shows  a 
clean  record,  one  is  inclined  to  speak  much  more 
favorably  of  the  chances  of  a  patient  as  regards 
recovery,  and  more  especially  in  reference  to  the 
chances  of  non-return  of  the  malady. 


Nature  of  Mental  Derangement     23 

2.  There  are  not  a  few  cases  in  which  young  per- 
sons of  good  constitution  have  been  attacked  with 
so-called  "  acute  "   forms  of  insanity,  from  which 
they  have  entirely  recovered  after  a  few  months, 
and  have  remained  thereafter,  during  a  long  life, 
free  from  any  symptoms  of  a  return  of  the  malady, 
and  free  from  signs  of  permanent  or  chronic  mental 
injury. 

3.  The  prospects  of  such  a  convalescent  for  es- 
caping a  second  attack  must  depend  a  good  deal  on 
the  answers  given  to  such  questions  as  the  follow- 
ing:   First,   what  is  the  species   of   insanity  ?    for 
certain  forms  are  much  more  curable  (in  a  permanent 
sense)  than  others.      Second,  is  there  personal  free- 
dom from  neurotic  tendency  ?    Third,  can  we  point 
to  an  existent  cause,  like  mental  stress,  shock,  or 
sickness,  which   is   evidently  powerful   enough  to 
account  for  the  attack  of  insanity,  independent  of 
heredity  ?     For  if  we  can  show  the  gravity  of  the 
assault  from  without,  we  are  the  less  inclined  to 
believe  that  the  man  fell  from  intrinsic  weakness  of 
constitution.     Fourth,  is  there  freedom  from  family 
taint  of  insanity  ?'     Fifth,  if  a  relative  is  known  to 
have  been  attacked,  can  we  find  an  adequate  exter- 
nal cause  in  the  case  of  such  relative  ?  for,  as  above, 
under  Question  3,  such  a  fact  pleads  in  favor  of  the 
absence   of   hereditary  taint,   and  makes  the  case 
more  promising  for  both  parties. 

1  Krafft-Ebing  states  that  family  predisposition  makes  the  indi- 
vidual more  liable  to  attack,  but  lessens  the  probability  of  a  severe 
attack. 


24  Sanity  of  Mind 

4.  The  multiplication  of  cases  of  insanity  in  the 
patient's  family  group  is  a  very  serious  matter. 

5.  The  production  of  insanity,  feeble-mindedness, 
or  other  defects,  by  the  intermarriage  of  near  blood 
relatives   is   a  subject  of  great    popular  misunder- 
standing.    There  is  nothing  in  such  marriages,  be- 
tween sound  parties  with  good  family  history,  to 
cause  degeneration.     Following  the  indication  given 
in  paragraph  7,  we  must  give  a  broader  meaning  to 
the  word  "  soundness  "  than  simple  exemption  from 
obvious  psychic  disorders  ;  we  must  include  most 
of  the  great  "  constitutional  disorders."     When  an 
undesirable   tendency    exists   in   the   family,    it   is 
obviously  liable  to  be  found  in  the  constitution  of 
both  the  parties,  and  if  so,  the  tendency  is  likely  to 
be  fixed  or  strengthened. — The  evidence  from  statis- 
tics, on  the  large  scale,  does  not  convincingly  show 
a  marked  tendency  towards  mental  defect  in  the 
children  of  such  marriages.     In  pure,  healthy  stocks, 
in  secluded  regions,  very  frequent  marriages  of  rela- 
tives have  been  known  to  occur  for  many  generations 
without  deteriorating  the  breed  of  man.1 

1  Compare  statements  by  Shuttleworth  and  Beach,  in  Dictionary 
of  Psychological  Medicine,  vol.  i.,  p.  662,  on  effects  of  consanguin- 
eous marriage ;  also,  an  analysis  of  recent  views  given  in  E.  S.  Tal- 
bot's  Degeneracy,  its  Causes,  Signs,  and  Results,  pp.  82-87 ;  also, 
a  summary  by  Ireland,  in  Mental  Affections  of  Children,  1898, 
p.  16. 

A  great  diversity  of  opinion  has  been  expressed  upon  this  point. 
Many  of  the  earlier  statements  appear  to  have  been  based  on  the 
fallacious  method  of  collecting  the  unfavorable  cases,  and  disregard- 
ing others.  The  statement  in  the  text  is  meant  to  imply  the  verdict, 
"  Not  proven,"  as  far  as  present  evidence  goes. 


Nature  of  Mental  Derangement     25 

6.  The  propriety  of  a  given  marriage  is  often 
called  in  question.     A  person  may  have  reason  to 
doubt  the  advisability  of  the  step  in  his  own  case,  or 
in  that  of  a  ward.     It  is  out  of  the  question  to  lay 
down  rules  for  the  decision  of  such  cases  in  a  pop- 
ular book :  the  advice  here  given  is  to  lay  the  matter 
before  competent  and  fair-minded  medical  authority. 

7.  Direct,  identical  inheritance  of  a  given  form  of 
insanity  from  ancestor  to  descendant  is  quite  a  rare 
occurrence.     It  certainly  does  occur.     But  for  the 
most  part,  insanity  must  be  considered  as  forming 
only  one  of  a  large  group  of  constitutional,  more  or 
less  neurotic  disorders,  which  have  a  general  tend- 
ency to  cause  degeneration  of  tissue.     One  of  the 
most  remarkable  of  modern  discoveries  is  the  fact 
of  the  interchangeable  nature  of  these  disorders  in 
inheritance ;  a  fact  in  regard  to  which  we  shall  have 
more  to  say  in  the  next  chapter,  in  connection  with 
the  study  of  degeneracy. 

8.  The    tendency   or   susceptibility   to    insanity 
(which  is  all  that  is  inherited)  may  be  described  as 
consisting   in  an  unusual  instability  of  the  nerve- 
tissue  ;  a  want  of  power  of  resistance  to  the  assaults 
of  the  manifold  causes  of  insanity.    The  power  pos- 
sessed by  the  skilful   educator,   in  steadying  and 
strengthening  such  deficiencies,  is  very  great. 

9.  It  is  by  no  means  necessary  to  suppose  that  all 
of  this  instability  is  congenital,  or  derived  from  a 
parental  defect.     On  the  contrary,  a  large  number 
of  cases  doubtless  originate  in  persons  of  good  aver- 
age quality,  under  the  pressure  of  mental  shock,  or 


26  Sanity  of  Mind 

anxiety,  or  as  a  sequel  of  the  acute  fevers,  or  from 
poisonous  agents.  In  some  cases  the  attack  is  sud- 
den, but  it  is  characteristic,  on  the  whole,  of  these 
cases,  that  the  power  of  resistance  is  not  broken 
down  all  at  once,  and  the  disease  comes  on  by 
degrees. 

The  following  extract,  from  a  well-known  pen,1 
represents  a  point  of  view  from  which  legitimate 
encouragement  may  be  drawn : 

When  one  or  two  of  several  brothers  or  sisters  of  an 
individual  are  already  afflicted  with  insanity  .  . 
the  members  of  the  family  who  still  remain  sane  are  sub- 
jected to  a  very  definite  stress  of  considerable  intensity. 
The  fear  of  following  in  the  footsteps  of  their  relatives, 
and  of  themselves  becoming  insane,  is  so  urgent,  and  is 
attended  by  so  great  a  stress,  as  sometimes  of  itself  to 
bring  about  the  very  disaster  which  is  dreaded.  It 
would,  of  course,  be  untruthful  to  deny  that  persons  so 
related  are  exposed  to  greater  chances  of  becoming  in- 
sane— are  more  obnoxious  to  the  influence  of  stresses 
tending  to  produce  insanity — than  are  the  majority  of 
other  people;  but,  on  the  other  hand,  it  is  the  height  of 
folly  to  suppose  that,  because  a  person  has  one  or  more 
brothers  or  sisters  who  are  insane,  therefore  that  person 
stands  in  imminent  or  urgent  danger  of  himself  becoming 
insane.  The  operation  of  the  laws  of  heredity  secure 
that  the  tendency  of  each  individual  to  develop  in  the 
direction,  in  the  manner,  and  to  the  extent  of  the  average 
individual  of  the  race  from  whence  he  springs,  is  so  power- 

1  Charles  Arthur  Mercier,  M.D.,  Sanity  and  Insanity,  pp.  272, 
273. 


Nature  of  Mental  Derangement     27 

ful,  that  it  will  assert  itself  against  conditions  the  most  un- 
favorable ;  so  that  parents  who  differ  very  widely  from  the 
usual  standard  of  the  race  commonly  produce  children 
who  approximate  to  that  standard  very  closely;  and 
even  if  they  produce  one,  or  two,  or  more  children  who 
inherit  their  particular  divergence  from  this  standard,  the 
chances  are  quite  as  great  that  the  remaining  children 
will  follow  the  usual  course  of  development,  and  grow 
into  normal  average  individuals,  as  that  they  will  follow 
the  development  of  their  parents,  and  inherit  their  in- 
stability. If  persons  situated  in  the  way  supposed,  that 
is,  related  to  insane  brothers  and  sisters,  and  on  that 
account  worrying  about  their  own  sanity,  were  aware  of 
the  immense  number  of  perfectly  normal  people  who  are 
in  the  same  predicament  as  themselves,  they  would  find 
their  fears  considerably  allayed. 


CHAPTER  III 

DEGENERACY 

It  is  the  greatest  part  of  our  felicity  to  be  well  born. 

Anatomy  of  Melancholy. 

IN  the  last  chapter,  a  discussion  of  the  nature  of 
insanity  naturally  led  to  the  thought  of  its 
causation.  /Yhe  immediate  cause,  we  found,  might 
be  summed  up  under  the  head  of  perverted  nutrition 
of  brain,  j  Pushing  back  the  inquiry  another  step, 
we  encountered  the  usual  statement,  that  heredity 
is  a  common  cause;  but  that  statement  we  saw 
reason  to  reject  as  unphilosophical,  inasmuch  as  it 
fails  to  account  for  the  origin  of  the  first  case  in  a 
series.  The  true  essence  of  morbid  heredity  we 
found  to  exist  in  a  combination  of  two  facts :  first, 
continuity  of  cell-life  and  of  the  qualities  and  po- 
tencies therewith  associated  ;  second,  that  depression 
of  vital  force  known  as  Degeneration,  which  mani- 
fests itself  in  the  production  of  a  numerous  brood 
of  ill-featured  disorders,  one  of  which  is  insanity. 
The  present  chapter  will  be  largely  taken  up  with 
considerations  upon  Degeneracy. 

The  word  degeneration  can  be  used  in  two  senses. 
It  may  imply  a  descent,  a  retrograde  move  in  the 
scale  of  being,  as  when  the  number  of  teeth  dimin- 

28 


Degeneracy  29 

ishes,  or  the  legs  of  a  quadruped  shrink  to  the 
whale's  flippers,  or  the  parasitic  barnacle  loses  his 
organ  of  locomotion.  These  are  cases  in  which 
adaptation  to  environment  is  a  main  factor,  and  the 
health  of  the  individual  is  promoted  in  new  circum- 
stances. But  degeneration  means  something  very 
different  when  applied  to  the  noxious  influence  of 
evil  living,  or  nervous  strain,  or  deprivation  of  sun- 
light, or  starvation,  upon  the  vital  forces  of  an 
organism.  Such  influences  produce  a  condition  of 
exhaustion,  of  a  general  character,  which  cannot 
but  affect  the  ovum  through  impaired  nutrition. 
Loss  of  vigor  in  parent  implies  loss  of  vigor  in  off- 
spring. Such  loss  manifests  itself  in  two  ways — by 
deficient  or  misdirected  growth  (deformed  or  exces- 
sive or  defective  body),  and  by  a  great  variety  of 
tendencies  to  diseased  action,  too  numerous  to  be 
named  here,  including  the  tendency  to  insanity. 

The  modern  student  of  heredity  cannot  fail  to  be 
confronted  with  the  recent  doctrine  of  Weismann, 
who  denies  the  possibility  of  the  inheritance  of  ac- 
quired traits.  If  I  do  not  mistake  his  position,  he 
intends  to  deal  with  normal  organisms.  Cases  which 
depend  on  defect  of  constitutional  vigor  would 
doubtless  not  be  claimed  as  coming  under  his  pro- 
hibition. That  a  man  of  originally  sound  health 
could  "  acquire  the  trait  "  of  chronic  drunkenness, 
with  immunity  as  respects  the  mental  health  of  his 
children,  would  not  probably  be  claimed ;  or  if  the 
claim  were  made,  it  might  safely  be  disregarded. 
The  whole  question  seems  to  me  to  lie  outside  of 


30  Sanity  of  Mind 

the  Weismann  theories.  The  impairment  of  vigor 
may  take  the  form  of  a  faulty  bio-chemical  habit  of 
the  tissue,  acquisition  of  vulnerability  in  any  tissue 
(the  nervous  tissue  included),  defect  in  quantitative 
power  of  assimilation  of  food,  in  circulation,  in 
energy  of  brain-tissue  in  general. 

Whatever  view  we  may  hold  as  to  the  essential 
nature  of  insanity,  we  cannot  avoid  the  admission 
that  its  occurrence  is  largely  a  matter  of  individual 
susceptibility.  In  identical  circumstances,  some 
men  will  become  insane  while  others  do  not.  The 
liability  to  become  deranged  is  ascribed  to  want  of 
resisting  power,  or,  to  use  an  expression  which  has 
become  quite  established  among  alienists,  "  nervous 
or  mental  instability." 

There  are  all  degrees  of  instability.  Some  persons 
may  be  so  firmly  built  that  no  conceivable  griefs 
or  tortures  would  shake  their  reason.  This  is,  per- 
haps, rather  a  matter  of  speculation  ;  but  we  do 
know  that  some  withstand  an  inconceivable  stress, 
while  others  succumb  to  shocks  or  influences  so 
slight  that  they  escape  notice.  And  there  is  really 
no  dividing  line — it  is  all  a  question  of  degree — most 
persons  have  in  them  the  possibility  of  yielding  in 
conceivable  circumstances.  The  contagious  disorders 
of  the  mind  show  this  well.  Men  in  a  mob  lose  their 
heads  in  a  frenzy  of  anger.  An  army  in  battle  may 
be  steadily  fighting,  and  in  a  moment  some  unex- 
plained event  deprives  them  of  judgment  and  cour- 
age, and  sweeps  them  in  panic  off  the  field.  The 
dancing  manias  of  the  Middle  Ages,  and  the 


Degeneracy  31 

"  jerks  "  of  our  rustic  camp-meetings,  are  similar 
phenomena,  wherein  whole  masses  of  population 
were  swept  into  one  common  frenzy.  That  a 
roomful  of  girls  may  go  off  into  hysterics  in  imita- 
tion of  a  single  victim,  is  a  familiar  fact. 

This  susceptibility  to  temporary  mental  derange- 
ment is  almost  universal.  The  susceptibility  to  the 
graver  disturbances  called  insanity  is  rather  general. 
I  believe  that  with  suitable  appliances  one  might 
safely  contract  to  manufacture  it  on  a  wholesale 
basis,  as  the  criminal  condition  is  manufactured  by 
the  wholesale  in  "  slum  "  life.  But  in  insanity,  as 
in  crime,  there  is  a  class  whose  susceptibility  to  in- 
jurious impressions  is  greatly  heightened  by  inborn 
defects.  These  are  the  victims  of  degeneracy. 
Life's  trials  sift  them  out,  and  they  are  consigned 
to  asylums  ;  but  others,  who  have  succeeded  in  es- 
caping downfall,  remain  in  society  ;  though  their 
posterity  may  be  making  ready  to  fill  up  the  list  of 
"  inmates  "  by  and  by,  or  by  good  hap  to  be  res- 
cued by  wise  education. 

As  a  generalized  expression  of  the  origin  of  in- 
sanity, idiocy,  and  the  allied  states,  degeneracy  is 
of  the  utmost  importance.  It  would  be  going  too 
far,  doubtless,  to  say  that  it  explains  all  of  acute  in- 
sanity ;  but  as  an  hypothesis  it  explains  and  unifies 
so  much  that  it  deserves  full  attention  and  testing. 

The  following  definition  is  borrowed  from  Nacke  * : 

1 G.  Nacke,  "  Degeneration,  Degenerationszeichen  und  Atavis- 
mus,"  Archiv  f.  Kriminalanthropologie  u.  Kriminalstatistik,  Bd. 
2,  H.  3  ;  quoted  in  Amer.  Journal  of  Sociology,  vol.  v.,  No.  i,  p.  128. 


32  Sanity  of  Mind 

Degeneracy  is  characterized  by  a  marked  slowing  of 
the  vital  activities,  together  with  a  lessened  power  of  re- 
sistance to  noxious  influences  of  any  kind.  There  is  an 
increasing  tendency  of  the  whole  organism  towards  phy- 
sical and  psychical  infirmity.  We  have  to  do  with  a 
morbid  state  of  affairs  which  may  arise  through  diseased 
conditions  in  the  germ  from  which  the  organism  takes  its 
rise,  or  through  nutritional  disturbances  in  utero,  or  dur- 
ing the  first  years  after  birth.  It  is  through  having  this 
pathologic  background  upon  the  one  hand  and  through 
the  presence  of  this  lowered  vitality  upon  the  other  that 
degeneration  is  to  be  distinguished  from  simple  abnor- 
mality, which  does  not  itself  imply  a  proneness  of  the 
organism  to  physical  and  psychical  disease.  Degenera- 
tion may  readily  pass  over  into  actual  disease,  but  when 
it  has  so  done,  the  disease  is  not  to  be  called  degenera- 
tion. Usually  the  reduction  of  the  vital  activities  is 
accompanied  by  the  presence  of  certain  anomalies, — the 
so-called  signs  of  degeneration  or  stigmata.  These  are 
occasional  variations  only,  and  those  of  the  morphologic 
kind  are  of  little  or  no  functional  importance;  they  ap- 
pear more  frequently  than  do  other  variations  upon  those 
persons  to  whom  for  other  reasons  we  apply  the  term 
"  degenerates." 

Before  giving  details  of  the  defects  of  organization 
which  are  classed  as  degenerations,  it  will  be  well  to 
note  the  existence  of  a  group  of  neuro-mental  dis- 
eases which  are  evidently  closely  related,  and  which 
share  the  signs  of  degeneracy  to  a  large  extent  in 
common. 

Insanity,  idiocy,  epilepsy,  hysteria,  and  to  a  frac- 
tional extent  crime,  are  close  kindred.  They  form 


Degeneracy  33 

the  leading  members  of  a  company  which  are  char- 
acterized by  heredity,  not  merely  direct,  but  inter- 
changeable, and  the  bodily  signs  of  defect,  of  which 
we  shall  speak  later,  are  shared  by  them  in  common/ 
to  a  remarkable  extent. 

With  these  are  associated  a  large  number  of  affec- 
tions of  a  nervous  character,  and  certain  which  are 
not  commonly  so  regarded.  Exophthalmic  goitre  is 
often  associated  with  mental  disease,  hysteria,  or 
epilepsy  in  the  same  person;  and  is  found  in  the 
same  family  with  many  other  affections,  as  chorea, 
paralysis  agitans,  angina  pectoris.  Chorea  has  a 
wide  range  of  affinities.  Neuralgia,  migraine,  and 
neurasthenia  have  very  strong  claims  to  be  con- 
sidered allied  to  insanity  or  epilepsy. 

The  association  of  so  large  a  number  of  disorders 
prepares  us  for  comprehending  the  doctrine  which  is 
announced  under  the  name  of  dissimilar  or  trans- 
formed heredity. 

It  is  the  power  which  this  class  of  disease  has  of 
changing  its  form  in  heredity  that  stamps  it  as  alien 
to  the  normal  laws  of  development,  and  throws  it  all 
under  the  one  category  of  degeneration,  whose  ten- \ 
dency  is  not  to  the  production  of  new  forms  of  life, 
or  new  organic  activities,  but  to  the  destjuoction  of 
the  individual  or  the  family  in  which  it  appears. 

F£reV  who  has  brought  these  considerations  very 
prominently  to  light,  makes  the  general  statement 
that 

whatever  be  the  origin  of  a  degenerate  person,  whether 
1  La  famille  ntvropathique,  1894,  p.  308. 


34  Sanity  of  Mind 

he  be  the  son  of  a  criminal  or  an  insane  person,  or  of  an 
epileptic,  or  a  victim  of  ataxia,  alcohol,  or  lead,  the  stig- 
mata which  he  bears  cannot  serve  to  distinguish  him 
from  another  degenerate  of  different  origin.  All  the 
stigmata  are  common  to  all  categories  of  degenerates, 
and  when  we  discover  a  new  stigma,  we  find  at  the  same 
time  that  it  is  not  special  to  a  group:  it  is  because  of  this 
circumstance  that  the  efforts  which  have  been  made  to 
establish  a  criminal  type  have  proved  vain. 

There  is  a  general  agreement  in  regard  to  the 
principal  stigmata.  Good  descriptions  are  found  in 
Talbot,1  Peterson,1  and  Fe"reV  not  to  speak  of  the 
extended  works  of  Lombroso  *  and  his  school. 

The  physical  signs  called  stigmata  comprise, 
first,  a  large  number  of  irregularities  of  the  bony 
skeleton,  showing  inequality,  excess,  or  deficiency 
of  growth  during  the  period  of  development.  There 
are  also  many  failures  of  development  in  the  soft 
parts. 

Asymmetry,  or  inequality  of  the  two  sides  of  the 
body,  is  almost  universal  in  the  human  race.  An 
excessive  degree  of  inequality,  however,  is  held  to 
be  significant  of  abnormality.  Examples  are  found 
in  the  one-sided  face  and  head,  and  the  very  short 
limb  on  one  side. 

Excessive  size  of  the  cranium ;  its  minute  size 

1  Degeneracy :   Its  Causes,   Signs,   and  Results,   "Contemporary 
Science  Series,"  1899. 
*  Nervous  and  Mental  Diseases,  1899. 
8  Loc.  cit.,  chap.  xvii. 
4  Criminal  Man, 


Degeneracy  35 

(microcephaly);  the  boat  and  pyramid  shapes;  over- 
development of  the  lower  jaw,  or  protrusion  (prog- 
nathism),  are  often  noted  in  the  degenerate. 

Defects  of  the  hard  palate  and  the  teeth  (espe- 
cially the  latter)  are  considered  among  the  most 
typical  marks  of  degeneracy.  A  vaulted  and  mis- 
shapen palate,  misplaced  teeth,  badly  shaped  teeth, 
and  the  absence  of  a  part  of  them,  form  striking 
evidences  of  failure  in  evolution. 

Other  bone  defects  are  found  in  the  spinal  column 
(e.  g.,  spina  bifida),  and  in  the  deformed  chest  or 
pelvis.  The  hand  may  have  an  extra  finger,  or  the 
fingers  may  be  out  of  proportion  in  length,  or  may 
have  the  wrong  number  of  bones.  There  are  also 
dwarfishness,  giantism,  and  infantilism  or  failure  to 
develop  adult  features. 

In  the  defects  of  the  soft  parts,  we  have,  first, 
peculiarities  of  the  ear,  in  various  ways.  It  may  lie 
flat  against  the  head  or  protrude  sharply.  The  lobe 
may  adhere.  Any  part  may  be  wanting  or  mis- 
shapen. Darwin's  tubercle  is  found  on  the  edge  of 
the  upper  back  part,  and  is  thought  to  be  an  atavism, 
analogous  to  the  pointed  ear  found  in  animals. 
Much  importance  is  attached,  probably  with  justice, 
to  anomalies  of  the  ear. 

Defects  of  structure  in  the  eye  are  numerous. 
Not  only  are  far-sight,  near-sight,  and  astigmatism 
counted  as  degeneracies,  thus  bringing  in  the  greater 
part  of  civilized  man  under  this  head,  but  deformed 
lids,  defectively  formed  pupils,  irregularly  tinted 
iris,  albinism,  and  pigmentary  retinitis  bear  witness 


36  Sanity  of  Mind 

to  failure  of  complete  development.  The  arched 
fold  of  skin  over  the  inner  angle  of  the  eye  is 
abnormal. 

Imperfect  closure  of  the  soft  parts  occurs  in  hare- 
lip and  some  genital  defects ;  supernumerary  organs, 
absence  of  organs,  clubfoot,  hernia,  should  also  be 
mentioned  here. 

The  presence  of  feminine  outlines  or  type  in 
males,  or  a  big  angular  frame  and  a  beard  in  women, 
are  also  stigmata. 

I  Arrested  or  ill-regulated  development  runs  through 
the  whole  series.  \  Its  general  effect '  is  to  cause  ugli- 
ness of  body  and  unloveliness  of  mind,  which  is 
common  enough  in  a  lesser  degree  as  developmental 
in  young  women  of  neurotic  heredity.  Coarse  skin, 
bad  expression,  deformed  and  ugly  person,  inhar- 
mony  of  movements — there  are  scores  of  young 
women  who  from  the  age  of  thirteen  steadily  get 
less  attractive  in  mind  and  body;  in  such  cases 
hereditary  neurosis  is  usually  found  on  careful  in- 
quiry. 

The  idiot  is  the  type  in  which  we  may  expect  to 
find  defects  of  development  in  greatest  abundance; 
his  condition  is  essentially  due  to  abnormal  and 
arrested  development.  Among  imbeciles  we  find 
large  numbers  of  persons  who  if  left  to  themselves 
would  not  have  sense  to  avoid  crime ;  we  also  find 
many  so-called  moral  imbeciles,  who,  with  fair  in- 
telligence, seem  to  have  little  appreciation  of  moral 
motives, — affection,  justice,  generosity,  compassion, 

1  Clouston,  Neuroses  of  Development. 


Degeneracy 


37 


honesty, —  and  a  more  or  less  considerable  number 
of  these  shade  off  into  the  class  of  habitual  criminals. 
A  truth  of  deep  importance  is  contained  in  the 
teachings  of  the  Italian  school  of  anthropologists.1 
But  the  claim  made  by  them,  that  a  criminal  future 
may  be  predicted  on  the  discovery  of  certain  stig- 
mata on  a  man's  person,  is  an  instance  of  the  exag- 
geration in  which  they  have  indulged.  Statistical 
inquiries  upon  criminals  have  been  carried  by  them 
to  a  great  extent.  The  following  table  from  Lom- 
broso *  embodies  some  of  his  most  general  conclu- 
sions : 

SIGNS    OF    DEGENERATION. 


WITH   FIVE 
OR   MORE 

WITH   THREE 
OR  MORE 

WITH   NONE, 
ONE,  OR  TWO 

Normal  

Per  cent. 
4. 

Per  cent. 
24. 

Per  cent. 
72 

Delinquents  

27.4. 

•33.  e 

•JQ.4. 

Epileptics  

2Q 

ec 

16 

Insane  

2S.1? 

CC.2 

18.4 

The  value  of  these  figures,  to  my  mind,  lies  in  the 
fact  that  they  point  clearly  to  a  tendency.  It  does 
not  greatly  matter  whether  they  exaggerate  that 
tendency — they  serve  to  call  up  to  our  mind  the  ex- 
istence of  a  distinct  class  of  the  degenerate  among 

1 A  convenient  synoptic  statement  of  views  held  by  different 
writers  in  criminal  anthropology  is  given  in  MacDonald's  Abnor- 
mal Man,  which  forms  Circular  of  Information  No.  4,  1893,  of  the 
U.  S.  Bureau  of  Education. 

'"Criminal  Anthropology,"  in  vol.  xii.  of  Twentieth  Century 
Practice,  p.  381. 


235OG4 


38  Sanity  of  Mind 

our  criminal  population.  I  am  very  far  from  be- 
lieving that  the  delinquent  class  in  America  ranks 
with  epileptics  and  the  insane  as  regards  bodily  de- 
;  generacy ;  but  in  that  class  there  is  a  sub-class  of 
degenerates. 

If  we  except  serious  deformities  of  the  cranium, 
there  is  no  one  of  these  stigmata  which  is  of  itself 
sufficient  to  excite  distrust  of  a  man's  character 
or  his  future.  The  best  and  brightest,  the  most 
amiable,  healthy,  and  sensible,  may  have  one  or  two 
queer  features  of  this  class.  They  signify  a  moment 
or  period  in  the  history  of  the  person's  development 
at  which  failure  occurred  in  one  direction.  A  good 
many  such  failures  occurring  in  one  individual  raise 
a  presumption  of  defect  of  some  sort  in  his  mental 
or  moral  make-up,  and  the  presumption  is  often 
justified. 

Nacke  expresses  the  point  of  view  very  fairly,  as 
follows : 

These  marks  are  of  importance  only  where  they  appear 
in  considerable  number  and  are  developed  to  a  high  de- 
gree, and  even  then  their  precise  value  is  problematical. 
They  furnish  an  indication  of  the  probable  inferiority 
of  the  bearer;  the  larger  their  number  and  the  more  ad- 
vanced their  development,  the  more  pronounced  may  be 
the  statements  concerning  the  degeneracy  they  indicate. 
Instances  are  not  unknown  where  we  have  a 
high  degree  of  degeneracy  present  with  few  or  none  of 
the  stigmata  appearing,  or  many  apparent  stigmata  with 
little  or  no  real  degeneracy.  Although  signs  of  de- 
generation are  undoubtedly  more  numerous  and  more 


Degeneracy  39 

pronounced  among  the  criminal  and  insane  than  among 
normal  individuals,  thus  giving  room  for  the  supposition 
that  there  is  some  intimate  connection  between  criminal- 
ity and  insanity  on  the  one  hand  and  degeneracy  upon 
the  other,  it  is  nevertheless  true  that  in  concrete  cases  the 
process  of  inferring  from  the  presence  of  stigmata  the 
existence  of  a  criminal  or  of  an  insane  person  is  some- 
thing to  be  undertaken  with  extreme  circumspection. 

The  "  psychic  stigmata  "  of  degeneracy  do  not 
require  enumeration  here.      The  expression  com- 
prises,   in   fact,    practically  all    constitutional   dis-| 
eases  of  the  mind,  nerves,  or  morals. 

The  connection  between  degeneracy  and  a  criminal 
life  has  been  made  much  of  by  the  Italian  school ; 
but  among  those  acquainted  with  the  unfortunate 
and  the  criminal  classes  in  America  it  is  safe  to  say 
that  different  views  are  entertained.  A  knowledge 
of  city  ways  and  of  reformatory  life  leads  to  the  con- 
viction that  most  of  our  criminals  are  made,  rather 
than  born — made  by  neglect  and  bad  example.1 

The  New  York  State  Reformatory  at  Elmira  rep- 
resents one  of  the  most  original,  judicious,  and  suc- 
cessful efforts  yet  made  in  our  country  for  the 
reforming  of  young  adult  criminals.  The  ages  of 
those  received  are  from  eighteen  to  thirty,  and  the 
crimes  are  not  boyish  errors,  but  substantially  of  the 
grade  of  felonies ;  it  is  with  bad,  though  not  con- 
firmed, criminals  that  they  have  to  do.  Mr.  Brock- 
way,  the  late  Superintendent,  expresses  his  estimate 
of  their  antecedents  and  qualities  as  follows* : 

1  See  Appendix.  *  Eighteenth  Year-Book,  1893. 


40  Sanity  of  Mind 

Sixty-eight  per  cent,  were  on  admission  practically 
illiterate;  seventy-five  per  cent,  were  without  regular  and 
remunerative  occupation;  ninety-two  per  cent,  were 
reared  without  the  restraints  and  benefits  of  good  home 
surroundings;  seventy-five  per  cent,  were  below  the 
average  of  their  class  as  to  susceptibility  to  ordinary 
motives;  and  the  same  ratio  not  sensitive  [to  moral 
motives]. 

Nine  tenths  of  these  young  men  came  up  amid 
neglect,  truancy,  and  bad  home  influences.  '  The 
slum  "  is  responsible  for  a  large  part  of  their  vicious- 
ness.  The  evil  effects  of  street  life  upon  children 
have  been  made  familiar  to  most  of  us  by  such 
studies  as  Jacob  Riis's  Ten  Years'  War  with  the 
Slum,  and  Josiah  Flynt's  Tramping  with  Tramps, 
and  need  not  be  dilated  upon  here.  \It  is  very  sel- 
dom that  a  real  mechanic  is  found  in  prison.  .  The 
lack  of  training  has  so  impressed  Mr.  Brockway 
that  he  remarks  that  "  industrial  inefficiency  is  at 
the  root  of  the  criminous  character,  and  their  ref- 
ormation is,  largely,  the  problem  of  their  industrial 
training  and  placing  in  industry." 

The  following  observations  from  Tramping  with 
Tramps  are  worth  quoting.  Be  it  remarked  that  a 
pretty  large  number  of  criminals  mingle  freely  with 
tramps. 

The  majority  of  those  criminals  that  I  am  acquainted 
with,  particularly  those  under  thirty  years  of  age,  if  well 
dressed,  could  pass  muster  in  almost  any  class  of  society; 
and  I  doubt  very  much  whether  an  uninitiated  observer 


Degeneracy  41 

would  be  able  to  pick  them  out  for  what  they  are.  After 
thirty  years  of  age,  and  sometimes  even  younger,  they 
do  acquire  a  peculiar  look;  but,  instead  of  calling  it  a 
criminal  look,  in  the  sense  that  the  instinctive  offender 
is  criminal,  I  should  describe  it  as  that  of  a  long  resident 
in  the  penitentiary.  Prison  life,  if  taken  in  large  doses 
and  often  enough,  will  give  the  most  moral  men  in  the 
world  prison  features;  and  it  is  no  wonder  that  men  who 
make  a  business  of  crime  and  are  so  much  in  prison  pos- 
sess them.  Even  men  who  are  busied  in  the  detection 
of  crime  have  more  or  less  similar  facial  characteristics. 
.  .  ./  When  he  nears  his  thirtieth  year  his  strength 
and  vigor  begin  to  fail  him.  ,  By  that  time  he  has  served 
a  number  of  years  in  prison,  and  it  is  this  existence  that 
drags  him  down.  .  .  .  Criminologists  who  believe 
in  the  innate  nervous  weakness  of  the  criminal  would  do 
well  to  test  their  own  nerves  during  even  voluntary  resi- 
dence in  prison-cells  in  order  to  estimate  their  power  to 
disturb  a  natural  equilibrium. 

The  number  of  insane,  however,  among  criminals 
is  large.  In  the  English  convict  establishments '  in 
1873  thirty  male  convicts  per  thousand  were  found 
suffering  from  weak-mindedness,  insanity,  or  epilepsy 
(three  or  four  times  the  normal  rate),  109  from  scrof- 
ula and  chronic  diseases  of  the  lungs  and  heart,  and 
231  had  congenital  or  acquired  deformities  and  de- 
fects. 

In  the  further  study  of  the  causes  of  insanity  we 
encounter  a  great  variety  of  occurrences,  circum- 

1  W.  Douglas  Morrison,  Introduction  to  Lombroso  and  Ferrero's 
Female  Offenders. 


42  Sanity  of  Mind 

stances,  and  diseases.  Among  the  more  important 
of  these  we  may  mention :  mental  stress,  anxiety, 
and  shock;  the  stress  of  child-bearing  and  nursing; 
the  climacteric  changes  of  life ;  syphilis ;  febrile  dis- 
eases; tubercle,  gout,  and  rheumatism1;  metallic 
poisons,  and  more  especially  the  poisons  of  intoxi- 
cation— alcohol,  opium,  cocaine,  and  others.  In  re- 
gard to  many  of  these  it  may  properly  be  said  that 
they  produce  a  degenerate  condition  within  the  life- 
time of  the  victim,  who  is  truly,  as  far  as  concerns 
"his  insanity,  a  self-made  man. 

This  is  true,  I  think,  to  a  large  extent  in  regard 
to  the  effects  of  alcohol,  i  Drunkenness  is  a  true 
cause  of  some  insanity. '}  A  brutal  love  of  intoxica- 
tion for  its  own  sake  exists  among  some  savage  races 
and  some  members  of  our  own  race ;  but  in  studying 
the  means  of  prevention/social  misery  must  be  con- 
sidered a  most  important  cause  ofdrunkennessJ 

Whoever  undertakes  to  reform  the  drink  habit 
must  aim  at  its  causes.  If  drink  causes  poverty,  it 
is  equally  true  that  poverty  causes  drinking.  Poor 
food,  hunger,  badly  cooked  food,  excessive  tea- 
drinking,  lead  to  the  use  of  a  good  deal  of  alcoholic 
stimulant. 

A  workingman's  table  set  with  soggy  bread,  meat 
fried  hard  in  fat,  coffee  indistinguishable  from  dirty 
water  ;  where  the  average  time  taken  for  a  dinner  was 

1  The  relation  which  gout,  rheumatism,  tuberculosis,  syphilis,  and 
other  degenerative  conditions  bear  to  nervous  disease  and  insanity  is 
briefly  and  well  discussed  in  chap.  i.  of  Mental  Affections  :  An  Intro- 
duction to  the  Study  of  Insanity,  by  John  Macpherson,  M.D.  (1899). 


Degeneracy  43 

seven  minutes,  and  the  women  sat  with  knife  in  one 
hand  and  teacup  in  the  other,  "  alternately  shovelling 
and  swigging  "  ;  where  nobody  ate  for  the  pleasure  of 
it,  but  only  because  they  were  empty, — 

such  was  the  description  of  the  boarding  tables  in 
one  of  our  New  England  towns  twenty  years  ago, 
given  me  by  a  friend  from  his  own  experience  of 
factory  life.  Most  of  these  men  drank  beer  or 
spirits. 

Cooking  is  the  only  kind  of  temperance  preaching  that  , 
counts  for  anything  in  a  school  course.     .     .     .     Five  \ 
years  ago  a  minister  of  justice  declared  in  the  Belgian  j 
Chamber  that  the  nation  was  reverting  to  a  new  form  of  I 
barbarism,  which  he  described  by  the  term  "  alcoholic 
barbarism,"  and  pointed  out  as  its  first  cause  the  "  in-  j 
sufficiency   of   the    food    procurable    by    the    working 
classes."     He  referred  to  the  quality,  not  the  quantity. 
The  United  States  experts,  who  lately  made  a  study  of 
the  living  habits  of  the  poor  in  New  York,  spoke  of  it  as 
a  common  observation  that  "  a  not  inconsiderable  amount 
of  the  prevalent  intemperance  can  be  traced  to  poor  food 
and  unattractive  home  tables."1 

There  is  a  great  temptation,  in  dealing  with 
causes,  to  mistake  the  true  relation  of  events.  The 
craving  for  liquor  often  precedes  an  outbreak  of  in- 
sanity, and  excess  of  sexual  impulse  is  another  fre- 
quent precedent  condition ;  but  in  a  large  number  of 
cases  these  excesses  are  the  premonitory  symptoms 

1  Jacob  A.  Riis,  A  Ten  Years1  War  :  An  Account  of  the  BattU 
with  the  Slum  in  New  York,  190x3,  p.  225. 


44  Sanity  of  Mind 

rather  than  the  true  cause,  and  both  may  be  the 
expression  of  an  hereditary  infliction. 

Echeverria '  remarks  that  a  tendency  to  drink  may 
immediately  precede  and  form  the  precursor,  rather 
than  the  cause,  of  epilepsy,  insanity,  hysteria,  neu- 
ralgia, or  paralysis.  In  such  cases  the  uncontrolled 
passion  or  craving  for  drink  is,  as  also  often  happens 
with  masturbation,  merely  the  sign  of  the  outbreak 
of  an  inherited  predisposition  to  insanity  or  epilepsy, 
or  of  .the  early  stages  in  the  evolution  of  either  of 
these  maladies  from  accidental  causes. 

The  same  writer  points  out  that  the  tendency  to 
drinking  is  one  of  those  metamorphoses  of  heredity 
which  often  occur  in  the  transmission  of  mental  and 
nervous  diseases  to  offspring,  without  necessarily 
implying  the  existence  of  alcoholism  in  the  parental 
stock.  And  conversely,  describing  the  intimate 
connection  which  exists  between  epilepsy  and  drink- 
ing, he  shows  that  parental  intemperance  often 
originates  a  tendency  to  epilepsy  in  the  offspring, 
probably  eighteen  per  cent,  of  the  cases  of  epilepsy 
arising  from  this  cause,  unconnected  with  insanity 
or  nervous  disease.  Viewed  in  a  proper  light,  both 
conditions  are  allied  manifestations  of  one  single  in- 
herited neurotic  predisposition,  and  successively  re- 
acting on  each  other.  /Neurotic  heredity  contributes 
to  a  larger  extent  than  even  vice  and  misery  to  the 
wide  spread  of  drinking  habits. 

Then  there  is  also  the  case  of  drunkenness  which 

1  "Alcoholic  Epilepsy,"  your.  Mental  Science,  January,  1881. 


Degeneracy  45 

follows  injuries  to  the  head  and  expresses  the  de- 
rangement caused  by  the  injury. 

In  asylums  for  the  insane  [writes  Maudsley]  will  be 
found  many  cases  of  insanity  that  have  been  complicated 
with  alcoholism,  particularly  a  peculiar  form  called  trau- 
matic insanity,  the  result  of  head  injuries,  after  the  re- 
ceipt of  which  there  is  a  remarkable  tendency  to  drink 
to  excess;  and  the  alcoholism  may  be  combined  with  the 
traumatic  insanity  in  every  conceivable  degree,  some- 
times outrunning  the  original  psychosis  in  its  influence 
for  evil. 

Tuke  calculates  that  the  cases  caused  by  intem- 
perance, in  the  asylums  of  England,  number  twelve 
per  cent,  of  the  whole. 

There  are  certain  persons  who,  as  is  commonly 
said,  do  not  "  bear  well  "  an  ordinary  quantity  of 
an  alcoholic  beverage.  Their  reaction  is  abnormal ; 
a  slight  alcoholic  excess  produces  in  them  a  condi- 
tion which  presents  the  appearance  of  insanity. 
Flechsig  observes  that  this  abnormal  sensitiveness  is 
apt  to  be  coincident  with  the  inheritance  of  mental 
or  nervous  disease,  or  with  stigmata  of  degenera- 
tion, or  with  symptoms  of  nervous  disease,  as  hys- 
teria, epilepsy,  and  many  others;  or  it  may  appear 
subsequent  to  a  concussion  of  the  brain,  or  typhoid 
fever,  or  the  long-continued  use  of  alcohol,  morphia, 
or  other  narcotics. 

It  is  doubtless  true  that  with  not  a  few  persons 
the  fact  of  addiction  to  drink  or  opium  is  only  the 
natural  outcome  of  a  character  which  is  so  far  de- 


46  Sanity  of  Mind 

generate  as  to  be  unable  to  pursue  any  steady  course 
of  activity,  and  is  only  satisfied  with  the  excitement 
of  sense  or  emotion ;  such  persons  may  give  up  drink 
only  to  adopt  opium,  or  gambling,  or  horse-racing. 

The  effects  of  opium  are  seen  in  deterioration  of 
the  moral  character,  and  not  infrequently  (as  with 
alcohol)  in  insanity.  /  Cocain  is  a  recent  and  much 
popularized  remedy  (e.  g.,  as  an  ingredient  in  catarrh 
snuff),  and  possesses  powers  of  wrecking  a  man's 
existence  more  terrible  than  any  other  drug.; 

The  uses  of  this  book  will  be  sufficiently  served 
without  discussion  of  the  insanities  caused  by  other 
poisons.  Something,  however,  should  be  said  of 
the  influence  of  the  "  diatheses  "  or  constitutional 
tendencies  known  as  the  tuberculous,  gouty,  and 
rheumatic.  The  connection  of  the  disorders  of 
these  classes  with  mental  and  nervous  disease  may 
not  be  obvious  at  the  first  view,  but  there  is  very 
strong  reason  for  linking  them  with  the  more  mark- 
edly and  obviously  neurotic  disorders  as  part  of  one 
chain  of  causes  and  effect.  Copious  illustrations  of 
these  mutual  relations  are  offered  by  F6re"  in  the 
book  already  quoted  from.  We  may  add  that,  in 
the  view  of  this  writer,  "  arthritism  "  and  the  neuro-; 
pathic  diathesis  are  two  kindred  states,  proceeding 
from  one  disorder  of  nutrition  differently  specialized, 
so  that  neuropathy,  scrofula,  tuberculosis,  rickets, 
asthma,  arthritism,  etc.,  are  found  variously  com- 
bined in  families,  and  in  certain  conditions  their 
manifestations  are  interchanged  or  mutually  excite 
one  another. 


Degeneracy  47 

The  way  in  which  many  morbid  conditions  may 
be  grouped  together  as  factors  of  bad  heredity  and 
degeneracy  is  practically  shown  in  the  statistics  of 
epilepsy.  By  way  of  example,  the  last  report  of 
Craig  Colony,  when  analyzed,  gives  us  the  following 
data  :  Of  the  157  patients  received  during  the  year, 
no  satisfactory  information  could  be  obtained  in  39 
cases ;  of  the  remainder,  all  but  9  had  bad  heredity. 
These  are  set  down  side  by  side  with  results  of  an 
inquiry  into  one  hundred  feeble-minded  patients  at 
Media,  as  follows  —  the  figures  for  the  latter  being 
placed  after  those  for  epilepsy : 

PATIENTS 

Epilepsy in  family  of  36,  13 

Insanity "  "  "  21,  10 

Feeble-mindedness "  "  "  o,  18 

Inebriety "  "  "  36,38 

Neurotic  affections  [hysteria,  chorea,  etc.] "  "  "  32,35 

Headache "  "  "  24 

Apoplexy,   paralysis,   and  other  grave   nervous 

lesions "  "  "  16,    6 

Suicide "  *'  "  2 

Tuberculosis "  "  "  38,56 

Cancer "  "  "  8,    6 

Rheumatism "  "  "  32 

Syphilis "  "  "  4,    2 

In  examining  a  published  list  of  supposed  causes, 
such  as  is  to  be  found  in  modern  asylum  reports, 
one  is  struck  with  the  fact  that  they  cannot  all  be 
causes  in  the  same  sense.  "  Inheritance,"  "  alco- 
holism,"" injury  to  the  head,"  "  fright,"  act  in  four 
distinct  ways,  viz.,  by  predisposing  to  an  attack,  by 
poisoning  the  brain  cells,  by  gross  destruction  or 


48  Sanity  of  Mind 

inflammation  of  the  tissue,  and  by  what  we  may  call 
purely  mental  processes. 

In  the  study  of  causes  one  naturally  asks  whether 
official  statistical  data  are  not  attainable,  and,  if  so, 
whether  they  ought  not  to  form  the  unassailable 
basis  of  our  statements.  The  answer  is,  unfortu- 
nately, to  a  large  extent  in  the  negative.  Great 
masses  of  statistics  exist,  from  which  we  may  indeed 
learn  something,  but  which  are  nearly  worthless  as 
furnishing  solid  ground  for  the  study  of  causation. 

One  of  the  chief  difficulties  with  hospital  statistics 
is  the  want  of  a  common  ground  of  knowledge  and 
theory  on  the  part  of  those  who  mainly  collect  the 
data — the  practising  physicians  who  sign  the  certifi- 
cates of  admission  and  who  fill  out  the  question- 
blanks  for  the  asylum  records.  There  is  a  great 
lack  of  comprehension  of  the  theory  among  physi- 
cians in  general,  and  by  consequence  there  is  little 
general  ability  to  put  questions  and  investigate  facts 
in  the  philosophic  spirit  which  a  new  and  difficult 
subject  demands.  For  the  subject  is  a  new  one 
still;  new  classifications  and  new  theories  are  coming 
up  for  trial;  while  the  whole  subject  of  causation  is 
profoundly  influenced  by  recent  scientific  studies  of 
degeneration,  which  have  not  been  accessible  to  the 
average  man  until  within  a  very  few  years. 

As  an  instance  of  the  way  statistics  are  made,  I 
cite  one  of  the  best  and  best-known  of  our  Ameri- 
can asylums.  It  published  in  1899  a  table  of 
"supposed  causes"  of  insanity  in  11,379  cases. 
The  classification  is  alphabetical,  and  gives  rise 


Degeneracy  49 

to  some  curious  questions.  Why  is  "  apoplexy" 
separated  from  "  cerebral  hemorrhage"?  Why  are 
six  distinct  headings  made  of  worry,  mental  anx- 
iety, grief,  disappointment,  domestic  trouble,  busi- 
ness cares  and  perplexities  ?  What  is  the  value  of 
recording  "  ill-health  "  as  distinct  from  "  ill-health 
from  overwork,  exposure,  and  loss  of  sleep  "  ?  Why, 
among  nearly  12,000  cases,  is  the  causation  "  un- 
known "  in  one  third  ?  Why,  in  that  vast  number, 
is  it  recorded  that  only  101  suffered  from  "  heredity," 
only  20  from  "  congenital  defect,"  and  only  ONE 
from  "  organic  disease  of  the  brain  "  ? 

None  are  better  aware  than  those  directly  con- 
cerned in  the  gathering  of  such  statistics,  of  the  in- 
trinsic difficulty  of  the  subject  and  of  the  difficulties 
that  are  thrown  in  the  way  of  inquiry.1 

The  statistics  for  England  and  Wales,*  based  on 
the  assigned  causes  of  all  cases  admitted,  1888-92, 
give  17.3  per  cent,  under  the  head  of  "cause  un- 
known." The  existence  of  so  serious  a  vacancy 
would  seem  to  show  a  defect,  either  in  thoroughness 
of  inquiry  or  in  our  comprehension  of  the  subject  of 

1  "  I  have  never  attached  any  importance  to  any  table  of  this 
character  [»'.  t.,  of  assigned  causes]  that  I  have  seen  published.  It 
is  usual  to  enter  in  the  case-book  the  '  assigned  cause '  of  insanity 
furnished  by  the  friends  as  a  part  of  the  history  of  the  case.  It  is 
not  always  the  cause  which  the  physician  would  assign.  To  esti- 
mate the  cause  of  any  insanity  is  such  a  complex  operation  that 
sufficient  time  cannot  be  given  to  the  analysis  of  every  case  to  make 
the  results  of  value." — Dr.  John  B.  Chapin,  in  yournal  of  Nervous 
and  Menial  Disease,  December,  1897. 

*R.  S.  Stewart,  M.D.,  Jour.  Mental  Science,  vol.  xlii.,  1896. 


50  Sanity  of  Mind 

causation.  Hereditary  influences  were  noted  in  22.8 
per  cent.,  and  congenital  defect  in  5.7  per  cent.  Men 
suffer  the  most  from  business  troubles,  intemperance, 
and  accidents,  women  from  domestic  troubles,  and 
causes  connected  with  child-bearing  and  the  organs 
involved.  Intemperance  in  drink  and  sexual  rela- 
tions and  venereal  disease  form  a  group  often  found 
together,  and  as  causes  they  are  increasing  greatly, 
much  more  in  men  than  in  women,  and  more  in  the 
upper  than  the  lower  classes.  "  Selfish  indulgence, 
lustful  gratification,  insatiable  animalism,  general 
sensuality  and  fastness,  are  to  a  very  large  extent 
the  grand  parent-manufactory  of  the  evil."  General 
paralysis  is  an  increasing  disease, —  the  total  admis- 
sions for  five  years  ending  1892  being  8.9  per  cent. 
of  the  whole,  or  nearly  one  in  eleven. 

There  is  much  to  lead  us  to  take  a  gloomy  view 
of  the  prospects  of  civilized  humanity.  Pauperism, 
syphilis,  alcoholism,  the  abuse  of  opium  and  other 
narcotics,  are  commonly  believed  to  be  upon  the 
increase.  The  country  is  crowding  into  the  cities, 
leaving  the  one  more  lonely  and  making  the  other 
more  stifling.  The  stress  of  business  competition 
daily  grows  keener,  and  slow  starvation  is  the  lot  of 
whole  populations  of  honest  artisans.  Degeneracy 
springs  up  everywhere  before  our  eyes  from  this 
evil  seed.  Viewing  these  things  in  the  mass,  we 
are  appalled  —  but  separately,  each  offers  a  distinct 
problem  with  hopes  of  solution  at  the  hands  of 
psychiatry,  sociology,  penology,  and  education. 


Degeneracy  5 1 

Civilization  is  only  beginning  to  study  and  cure 
its  own  ills,  one  is  tempted  to  say.  And  yet,  what 
gains  have  already  been  made  for  human  welfare, 
and  how  little  credit  is  given  for  them !  Have  we 
forgotten  the  Jacquerie,  Wat  Tyler,  the  Black 
Death,  the  Inquisition,  the  Thirty  Years'  War  ? 
And  what  of  the  causes  of  the  French  Revolution  ? 

The  French  or  German  peasant  of  to-day  enjoys 
a  degree  of  physical  well-being  far  in  advance  of 
what  he  possessed  in  the  eighteenth  century.  Super- 
stition, with  its  train  of  psychic  epidemics,  the 
scourge  of  the  Middle  Ages,  is  far  less  virulent  and 
pernicious  than  formerly.  The  new  science  of 
sanitation  has  favorably  influenced  the  health  of 
the  masses.  Small-pox,  to  take  a  striking  case, 
has  almost  entirely  disappeared  from  Germany, 
where  vaccination  is  most  strictly  enforced.  Con- 
sumption, another  of  man's  great  scourges,  and 
closely  related  with  the  genetic  causes  of  insanity, 
has  diminished  in  England  by  one  third  in  forty 
years. 

Perhaps  the  most  disheartening  view  is  that 
rather  prevalent  one  which  sees  in  our  so-called  in- 
tellectual progress  a  chief  factor  in  modern  insanity. 
It  is  a  common  observation  that  among  races  which 
we  term  undeveloped,  insanity  and  idiocy  are  infre- 
quent. The  thought  has  been  expressed  with  epi- 
grammatic force  by  Tuke  ' : 

"  Insanity  is  simply  the  penalty  which  superior 

'  l  Daniel  Hack  Tuke,  Insanity  in  Ancient  and  Modern  Life,  with 
Chapters  on  its  Prevention,  1878,  p.  9. 


52  Sanity  of  Mind 

organisms  have  to  pay  for  their  greater  sensitiveness 
and  susceptibility.  Civilization  involves  risks  be- 
cause it  entails  a  higher  form  of  mental  life." 

It  were  doubtless  fairer  to  say  that  modern  civil- 
ization entails  new  forms  of  mental  life,  more  trying 
forms.  It  is  the  change,  the  competition,  the  pace 
at  which  we  live,  that  strains  us.  We  are  not  more 
intellectual  than  were  the  associates  of  Pericles,  of 
Augustus,  of  Leonardo  da  Vinci ;  but  we  are  forcing 
the  commonplace  man  to  try  to  stand  where  these 
men  did.  >  It  is  not  the  possession  of  intellectual 
superiority,  not  scientific  thought  and  work,  that 
endanger  men's  wits,  but  rather  the  intense  devotion 
of  gifted  but  unbalanced  minds  to  the  subjective 
life  and  the  emotional  side  of  art  and  poetry. 

In  conclusion,  one  little  word  must  be  said  on 
behalf  of  our  betters — the  unhappy  people  of  genius 
who  are  so  commonly  labelled  "  degenerates  "  by 
prosaic  Science.  They  have  more  to  suffer  than  the 
rest;  let  us  try  to  mingle  gratitude  with  our  justice. 
Genius,  like  a  sport  in  horticulture,  exalts  one  part 
of  the  being  at  the  cost  of  the  rest,  and  tends  to 
disturb  the  equilibrium  which  is  the  boast  of  the 
average  man.  But  the  human  race  cannot  do  with- 
out its  leaders. 


CHAPTER   IV 

EDUCATION 

Alas  !  how  much  there  is  in  education,  in  our  social  institutions, 
to  prepare  us  and  our  children  for  insanity  ! 

Wilhelm  Meister. 

A  PERSON'S  individuality  is  made  up  of  the 
two  factors,  heredity  and  environment.  This 
is  the  current  statement  as  we  hear  it  to-day.  There 
is  the  greatest  difference,  however,  in  the  application 
of  the  statement.  To  one  class  of  minds  the  doc- 
trine of  heredity  appeals  with  overpowering  force, 
while  others  look  upon  the  child's  mind  and  char- 
acter as  plastic  clay  which  we  can  mould  into  any 
form  we  please.  After  what  has  been  said  in  pre- 
vious chapters  it  will  be  needless  to  vindicate  my 
appreciation  of  the  force  of  heredity.  In  the  pres- 
ent chapter,  however,  it  seems  to  me  that  we  are 
approaching  the  more  important  side  of  the  case. 

In  speaking  of  environment  we  cannot  omit  edu- 
cation ;  and  in  describing  education  we  must  include 
vastly  more  than  "  schooling."  For  the  child  of 
defective  or  neurotic  heredity  no  point  of  the  daily 
life  and  surroundings  can  be  neglected — all  must 
be  broadly  and  wisely  directed  into  the  ways  of 

53 


54  Sanity  of  Mind 

wholesome  and  strong  living.  And  at  the  same 
time  we  must  at  every  step  bear  in  mind  hereditary 
predispositions ;  each  year  of  the  educational  period, 
from  birth  up  to  twenty-five,  has  its  peculiarities, 
and  in  every  year  heredity  has  special  ways  of 
showing  itself. 

The  child  has  sometimes  been  regarded  as  a 
smaller  man,  of  lesser  force,  but  having  nearly  the 
same  qualities  and  faculties  as  a  grown  person  ex- 
cept when  untamed  natural  depravity  breaks  forth 
and  amazes  his  elders.  Such  a  view  answered  the 
purpose  of  the  old-fashioned  schoolmaster  well 
enough,  furnished  as  he  was  with  strap  and  ferule 
to  combat  diabolical  restlessness  and  frivolity;  a 
gleam  of  better  comprehension  visited  the  jurist 
who  declared  it  unsuitable  to  hang  an  infant ;  other 
gleams  illuminated  the  teacher  who  saw  that  the 
mathematical  faculty  is  weak  in  little  children ;  true 
wisdom  tempered  the  zeal  of  the  priest  who  post- 
poned the  date  of  the  first  communion  to  the 
fifteenth  year.  But  the  most  comprehensive  view 
of  the  nature  of  children  and  the  educational  pro- 
cess was  his  who  said  that  "  a  child's  chief  business 
is  to  grow  "  ;  or,  in  other  words,  that  the  child  can- 
not be  rightly  understood  by  his  teachers  except  by 
studying  the  law  of  his  development,  j  Childhood 
and  youth  are  not  a  state,  but  a  growth  and  a  be- 
coming. As  a  foundation  for  this  study  we  need  an 
acquaintance  with  the  data  of  bodily  growth,  and 
change  in  the  bodily  proportions,  organs,  and 
powers.  Side  by  side  with  this,  a  study  of  the  rise 


Education  55 

and  growth  of  mental  faculty  should  be  carried  on. 
A  recognition  of  the  different  periods  into  which 
life  divides  itself,  and  a  study  of  the  great  crises  in 
life,  show  how  each  age  has  its  own  traits,  its  own 
progress,  its  own  dangers  from  disease,  while  the 
mind,  even  more  than  the  body,  craves  change  of 
method  and  nutriment  as  it  passes  from  stage  to 
stage. 

As  we  have  already  said,  schooling  is  not  equiva- 
lent to  education.  Education  implies,  first,  a  sup- 
ply of  food,  clothing,  shelter,  sunlight ;  next,  bodily 
exercise  and  training;  next,  mental  illumination; 
and,  crowning  the  whole,  development  of  habits, 
morals,  and  the  will.  In  a  word,  it  is  the  "  raising 
and  breaking-in  "  of  the  young  animal  —  the  whole. 
"  upbringing  "  of  the  young  person. 

The  present  chapter,  however,  is  not  intended  as 
a  general  treatise  on  education.  Its  purpose  is  lim- 
ited to  showing  some  of  the  ways  in  which  mental 
soundness,  strength,  and  stability  may  be  influenced, 
favorably  or  the  reverse,  by  early  training. 

The  facts  of  a  child's  increase  in  size  and  weight 
are  often  mentioned  under  the  designation  of  "  the 
law  of  growth."  In  studying  this  law,  it  is  most 
important  to  remember  what  is  really  implied  in  the 
word  "  growth."  Do  not  let  us  imagine  it  as  a  sim- 
ple addition  to  bulk.  Human  growth  is  not  a  sim- 
ple increment,  like  the  successive  rings  around  the 
centre  of  a  tree :  it  is  a  series  of  novel  and  unprece- 
dented occurrences,  revolutionary  in  character,  one 
succeeding  the  other  at  regular  intervals  in  a  way  to 


56  Sanity  of  Mind 

supersede  and  supplant  old  ways;  outgrowing  old 
weaknesses  and  growing  into  new  ones ;  dropping  a 
childish  gift  for  a  manly  endowment,  a  primitive 
charm  for  a  riper  grace ;  now  inoculating  the  whole 
being  with  a  new  and  often  a  renovating  virus,  now 
moving  steadily  forward  for  years  in  a  fixed  course 
of  expansion;  and  all  the  while  (which  is  our  chief 
concern)  establishing  its  own  habit  of  psychic  life^ 
growing  into  sound  or  unsound  ways  of  thought  and; 
plan,  getting  into  harmony  or  confusion  with  its; 
own  nature,  linking  itself  in  wholesome  bonds  with 
its  fellows  or  morbidly  dissociating  itself.  The 
educational  period  is  the  time  during  which  every- 
thing is  to  be  done  to  counteract  morbid  inheritance 
and  to  build  the  mind  for  sanity.  It  is  the  great 
stojie-age,  the  prehistoric  period  in  the  life  of  a 
man,  the  hunting,  herding,  and  piratical  period, 
which  shapes  the  grand  outlines  of  man  into  some- 
thing which  civilization,  when  it  comes,  can  put  at 
once  to  use.  It  is  full  of  hints  and  warnings  of 
danger  to  the  future  mind-life ;  series  after  series  of 
nervous  or  mental  disorders  stand  ready,  each  at  its 
appropriate  period  of  life,  to  give  the  danger  signal 
and  call  a  halt. 

The  main  statistical  points  of  the  outline  of  the 
law  of  growth  may  be  briefly  sketched  as  follows : 

The  complete  stature  is  attained  by  men  about 
twenty-four  and  twenty-five;  by  women  two  years 
earlier.  With  later  life  we  are  not  now  concerned. 

Growth  is  not  uniform,  but  is  divided  into  two 
periods  of  rapid  and  one  of  slow  growth.  Beginning 


Education  57 

life  with  tremendous  initial  velocity,  the  infant 
trebles  his  weight  in  his  first  year.  After  this, 
growth  is  less  and  less  rapid  in  proportion  to  size 
(though  not  absolutely  less)  till  puberty.  Then 
comes  a  second  extraordinary  start  in  growth,  last- 
ing some  three  years,  and  gradually  diminishing 
until  true  adult  life  is  reached. 

The  head  and  brain  get  almost  their  entire  growth 
in  bulk  by  the  end  of  the  seventh  year. 

These  facts  enable  us  to  divide  growth  into  four 
periods:  i.  Infancy.  2.  Childhood.  3.  Boy- and 
girlhood  (from  seven  to  thirteen  or  fourteen).  4. 
Puberty  and  adolescence  (to  twenty-five). 

It  is  very  interesting  to  note  some  of  the  ways 
in  which  Nature  first  sketches  out  the  plan,  and 
later  fills  it  in.  The  tall  boy  is  but  the  sketch  of 
a  man,  his  muscles  awkward,  his  frame  not  filled 
out.  The  sexual  appetite  comes  ten  years  before 
the  full  desirable  firmness  of  constitution  is  reached. 
The  head  of  the  child  of  seven  is  almost  as  big  as  an 
adult's,  but  it  takes  seventeen  or  eighteen  years 
after  that  for  the  brain  cells  to  ripen  by  time  and 
rise  to  their  full  power.  It  would  seem  that  the 
furnishing  of  the  house  is  a  much  slower  process 
than  the  external  construction. 

The  mental  history  of  each  individual  goes  back 
to  his  beginnings.  In  determining  the  sanity  of 
the  future  adult,  infancy  is  important,  childhood  is 
important,  and  puberty  and  adolescence  are  prob- 
ably most  important  of  all. 

During  these  stages  of  development  the  child  is 


58  Sanity  of  Mind 

indeed  sheltered  from  most  of  the  causes  which  lead 
to  insanity  in  the  adult  —  strong  drink,  vice,  care, 
sexual  strain, —  and  so  we  find  that  relatively  few 
cases  are  recorded  during  the  first  fifteen  years  of 
life.  (  But  it  is  during  these  years  (and,  in  fact,  up 
to  the  age  of  twenty-five)  that  we  are  to  look  for  the 
development  of  innate  tendencies  of  various  sorts, 
which  display  themselves  in  the  form  of  various 
diseases,  j  Each  period  of  childhood  is  marked  by 
tendencies  to  a  special  series  of  disorders.  As  the 
child's  mental  and  bodily  habits,  so  also  do  his 
common  diseases,  differ  from  those  of  the  adult. 

Among  "  children's  diseases"  we  find  a  whole 
series  of  nervous  disorders,  which  are  held  to  be 
very  significant  of  a  child's  constitution.  They 
indicate  his  faulty  tendencies,  and  in  a  general  way 
point  out  the  weaknesses  we  have  to  guard  against. 
If  they  can  be  held  in  check  during  the  period  of 
growth,  while  the  nervous  tissue  is  so  impression- 
able, and  while  nervous  and  mental  habits  are  being 
formed  for  the  rest  of  life,  it  is  certain  that  we  ac- 
complish a  great  work  for  the  sanity  of  the  future 
adult. 

We  will  therefore  give  attention  to  a  brief  state- 
ment of  the  principal  of  these  disorders;  for  a  cer- 
tain part  of  which  I  must  acknowledge  indebtedness 
to  Clouston's  very  suggestive  monograph.1 

I.  Birth  is  a  serious  crisis,  and  many  succumb  to 
the  strains  or  injuries  which  accompany  the  passage 
to  the  new  conditions  of  living.  More  than  one 

1  Neuroses  of  Development— passim. 


Education  59 

tenth  of  the  children  in  New  York  die  under  one 
month.  During  infancy,  although  the  power  of 
assimilating  food  is  immense,  there  is  little  adapta- 
bility to  change  of  diet ;  there  is  great  susceptibility 
to  slight  defects  in  the  quality  of  food,  and  an  in- 
ability to  resist  heat,  which  in  combination  produce 
the  numerous  deaths  from  alimentary  trouble  in 
summer. 

2.  In  infancy  and  childhood,  the  exceedingly 
rapid  growth  of  the  brain  predisposes  to  certain  af- 
fections. Appeals  of  all  sorts  are  made  to  the  child's 
newly  wakened  faculties,  a  flood  of  new  impressions 
of  most  interesting  purport,  which  he  seeks  with 
imperfect  powers  to  combine  and  compare.  It  i 
in  the  power  to  combine  and  compare  that  he  i 
physiologically  defective.  He  is  extremely  quick 
in  the  assimilation  of  ideas  through  impressions 
from  without,  but  his  use  of  them  is  apt  to  be  what 
we  call  fanciful;  he  does  not  judge  from  a  fund  of 
experience;  in  short,  the  control  of  an  organized 
intelligence  is  wanting.  There  is  a  want  of  self- 
restraint,  mentally,  emotionally,  and  in  the  muscu- 
lar life.  He  habitually  explodes,  instead  of  burning 
with  a  steady  and  useful  flame.  ;'  Technically  speak- 
ing, he  lacks  inhibitory  power.} 

In  illustration  of  this  susceptibility  we  have  the 
fact  that  young  children  are  often  liable  to  delirium 
of  a  transitory  sort  during  mild,  feverish  condi- 
tions. Bad  dreams  with  frightfully  real  impressions 
(technically  called  night-terrors)  are  found  at  this 
age.  ^And  in  the  motor  sphere,  the  frequency  of 


60  Sanity  of  Mind 

convulsions  in  early  years  confirms  the  impression  of 
the  instability  of  nervous  function. 

Rickets  is  especially  a  disease  of  early  childhood, 
and  its  stamp  is  often  found  on  the  bodies  of  chil- 
dren. It  is  much  more  of  a  brain  and  nerve  disease 
than  is  commonly  supposed ;  it  is  founded  on  hered- 
itary nervous  tendencies  such  as  are  developed  in 
parents  by  the  devitalizing  influence  of  city  life, 
and  is  fostered  in  children  by  the  lack  of  the  great 
nerve-strengthener,  sunlight. 

These  four  disorders  are  considered  by  Clouston 
as  of  the  utmost  importance  for  the  child's  future; 
he  finds  them  frequent  in  the  offspring  of  insane 
and  epileptic  patients. 

The  educator  should  infer  from  these  facts  the 
necessity  of  a  quiet  and  unstimulating  life,  with  the 
silent  invigoration  of  sun,  air,  and  good  food,  in 
the  earlier  years  of  childhood. 

The  choice  of  a  nurse,  governess,  or  teacher  may 
have  much  to  do  with  making  a  child  nervous  or 
steady ;  the  best  intentions  will  not  impart  that 
subtile,  contagious  quiet  and  harmony  which  is  so 
good  for  children.  The  family  concert  is  not  always 
pitched  in  the  right  key  for  the  baby's  best  good. 
Parents,  aunts,  and  cousins  combine  in  stimulating 
the  little  one  by  dandling  and  tossing,  by  pokes, 
chuckles,  and  loud,  sudden  appeals,  by  all  sorts  of 
upsetting  procedures  calculated  to  elicit  smiles. 
Among  the  poor,  infants  have  to  sleep  with  the  rest 
in  an  atmosphere  tainted  with  tobacco  smoke,  which 
occasionally  does  marked  harm.  The  sleep  of  the 


Education  61 

children  of  the  poor,  also,  is  often  in  cities  much 
cut  off  by  their  habit  of  playing  out  in  the  street  till 
the  elders  are  ready  to  let  them  go  to  bed. 

3.  Between  seven  and  thirteen  the  chief,  or  one 
of  the  chief  diseases  is  chorea.  Clouston  observes 
that  near-sightedness,  headache,  somnambulism, 
and  nervous  asthma  appear  at  this  age  in  many 
cases,  though  on  the  whole  these  years  are  rather 
free  from  disease. 

Chorea  (St.  Vitus's  Dance)  is  most  frequent  from 
eight  to  eleven,  and  is  seldom  found  before  six  or 
after  fifteen ;  it  is  therefore  eminently  a  disease  of 
the  primary  and  grammar  schools.  It  resembles 
hysteria  in  its  preference  for  the  female  sex  —  two 
or  three  girls  being  attacked  for  one  boy.  It  is  said 
by  Clouston  to  be  found  often  in  families  where 
epilepsy,  insanity,  or  dipsomania  prevails ;  he  thinks 
it  always  has  a  neurotic  heredity.  It  is  important 
to  recognize  its  relation  to  school  work.  A  child 
with  this  complaint  should  be  taken  from  school  at 
once,  not  only  for  its  own  sake,  but  for  that  of  the 
schoolmates,  for  the  trouble  has  a  tendency  to  be- 
come contagious.  Dr.  Wm.  Dale,  in  a  late  issue  of  ^ 
the  Lancet,  says  that  "  brain  pressure  of  many  \ 
studies  in  delicate  and  half-starved  girls  is  the  most  > 
potent  cause  of  chorea  in  our  [English]  elementary 
schools."  The  ultimate  mental  consequences  of  the 
disease  are  diminished  attention,  impaired  memory, 
irregular  speech,  and  whimsical,  irritable  temper. 
Dr.  Sturgis,  physician  to  the  Hospital  for  Children 
in  London,  speaks  of  the  restlessness,  the  odd  tricks 


62  Sanity  of  Mind 

of  face  and  hands,  the  misbehavior,  which  are  apt 
to  be  the  forerunners  of  chorea,  and  puts  teachers 
on  their  guard  against  the  injustice  of  punishment 
in  such  cases. 

When  school  children  (and  especially  girls  between 
/  seven  and  twelve)  alter  in  temper,  work  less  well  and  less 
willingly  than  usual,  get  untidy  and  slovenly — in  a  word, 
degenerate  mentally  and  bodily  —  inquire  of  the  mother 
as  to  the  home  conduct  and  temper.  Ask  particularly 
how  the  child  sleeps;  whether  she  complains  of  headache 
or  limb-ache;  whether  her  food  is  sufficient. 

He  suggests  the  following  as  the  best  test,  and  one 
which  the  teacher  can  apply :  Bid  the  child  hold  up 
both  hands,  open,  with  extended  arms  and  palms 
toward  you.  If  this  is  done  steadily,  both  hands 
upright  and  both  alike  in  position,  the  disease  is 
absent,  and  is  not  coming  on.1  Of  course  it  is  not 
safe  to  say  that  the  disease  is  present  if  the  fingers 
do  twitch. 

There  are  various  occurrences  which  teachers  are 
in  a  position  to  observe,  which  would  help  them  in 
understanding  the  mental  condition  of  their  pupils. 
Such  observations  on  the  part  of  teachers  do  not 
supersede  the  physician's  work;  they  may  often 
anticipate  it  and  bring  things  to  notice  much  sooner 
than  would  otherwise  be  the  case.  A  serious  effort 
to  lead  teachers  to  these  observations  has  been  made 
by  Warner,  whose  immense  experience  as  a  school 

1  Article  by  Will  S.  Monroe,  in  American  Physical  Education 
Review >,  vol.  iii.,  No.  I. 


Education  63 

examiner  in  London  has  entitled  him  to  speak  with 
authority.  Two  of  his  books  especially  deserve 
mention  as  attempts  to  found  a  practical  system  in 
mental  hygiene  for  schools.1  Their  chief  thesis  is 
the  correlation  of  bodily  movement  with  psychical 
condition ;  they  explain  how  to  observe  nervousness 
as  indicated  by  the  twitches  and  often  spontaneous 
movements  of  the  muscles  of  face  and  fingers,  asym- 
metry of  posture,  voice,  and  in  general  the  signs  of 
abnormal  physico-mental  conditions  as  given  by 
unconscious  acts.  A  practical  suggestion  which  has 
proved  fruitful  in  the  training  of  dull  children  is  set 
forth  in  chapter  vii.  of  the  second-  named  book, 
consisting  of  exercises  in  training  the  attention  to 
definite  controlled  movements  of  the  fingers,  hands, 
and  eyes. 

.  Stuttering  is  a  disease  of  the  same  period  as 
chorea,  and  is  often  associated  with  chorea-like 
movements.  It  is  obviously  a  nervous  complaint. 
Dr.  Hartwell  has  called  attention  to  the  fact  that  its 
rise  coincides  with  the  period  of  rather  early  child- 
hood during  which  the  smaller  muscles  have  not 
yet  acquired  facility  in  coordinating,  or  working 
together.  It  is  his  belief  that  in  some  children  we 
require  an  amount  of  attention  to  delicately  adjusted 
finger  work,  in  kindergarten  occupations  and  in  writ- 
ing, which  exceeds  the  ability  of  the  imperfectly 

1  A  Course  of  Lectures  on  the  Growth  and  Means  of  Training  the 
Mental  Faculty,  by  Francis  Warner,  M.D.,  London,  1890;  The 
Nervous  System  of  the  Child,  its  Growth  and  Health  in  Education, 
by  the  same,  1900. 


64  Sanity  of  Mind 

developed  nerve  centres  for  fine  coordination,  and 
that  this  excess  tends  to  produce  other  disorders  of 
coordination,  as  seen  in  the  failure  of  tongue,  lips, 
pharynx,  and  respiratory  muscles  to  work  together 
in  producing  orderly  speech.  Boys  are  slower  in 
learning  to  coordinate  than  girls,  and  they  are  far 
more  subject  to  stuttering.  When  taken  in  hand 
very  early,  a  surprising  amount  of  improvement  is 
obtained  with  a  moderate  course  of  training,  con- 
ducted in  special  classes  with  the  aid  of  vocal  and 
general  gymnastics  and  music.  No  pains  should  be 
spared  to  lighten  the  load  of  mortification  which 
this  infirmity  often  places  on  young  persons. 

Hysteria  is  exceedingly  common  in  young  women, 
and  far  more  so  than  is  generally  known  in  children. 
The  statistics  quoted  by  Clouston  from  Landouzy 
and  Briquet  give  216  cases  as  occurring  before  fif- 
teen, 396  from  fifteen  to  twenty-five,  and  only  169 
during  later  life.  It  is  worth  noticing,  also,  that 
one  third  of  the  cases  under  fifteen  occur  in  boys 
(Cloplatt).  These  are  important  facts  for  teachers 
to  know.  The  condition  of  things  in  a  hysterical 
person  is  not  without  analogies  to  what  we  find  in 
chorea  and  stuttering.  A  tendency  to  it  is  shown 
by  being  restless  with  the  eyes,  fidgety  with  the 
fingers,  assuming  twisted  postures;  by  excess  in  ex- 
pressing emotion  by  laughter,  words,  or  gesture; 
by  want  of  control  over  words  and  actions.  '  This 
brain  condition  appears  to  consist  essentially  in  too 
great  a  governance  of  mental  states  by  impressions 
from  other  parts  of  the  body,  rather  than  by  sights 


Education  65 

and  sounds  from  without  "  (Warner).  Such  a  ten- 
dency must  be  combated,  not  merely  in  the  usually 
prescribed  way  of  "  controlling  one's  feelings,"  but 
by  systematic  bodily  training  to  the  word  of  com- 
mand in  movements  which  cultivate  the  power  of 
controlling  attention  along  with  muscular  self- 
control.  Such  training  is  afforded  by  Swedish 
gymnastics  and  the  like.  Its  benefit  lies  partly  in 
the  improvement  of  the  health,  partly  in  the  intro- 
duction of  new,  unemotional  trains  of  thought,  and 
also  largely  in  its  power  to  use  the  vagrant  energies 
of  the  unorganized  hysterical  mind  for  the  organiz- 
ing of  useful  and  graceful  functions.  In  a  word,  it 
supplies  an  urgent  need  of  the  hysterical  constitu- 
tion by  introducing  an  organized  relation  between 
the  parts  of  the  system. 

Near-sight  is  an  affection  scarcely  seen  in  the 
youngest  school-children,  but  which  increases  stead- 
ily in  frequency  up  to  the  college  age.  It  is  fully 
demonstrated  that  it  is  due  to  a  considerable  extent 
to  defective  lighting  of  the  school-room,  to  badly 
printed  school-books,  to  bad  arrangement  and 
shapes  of  desks  and  seats,  which  encourage  the 
faulty  habit  of  stooping  forward  and  bringing  the 
eyes  close  to  the  book.  Hereditary  predisposition 
has  considerable  influence.  There  is  reason  to  think 
that  the  general  condition  of  the  health  has  a  good 
deal  to  do  with  myopia  and  astigmatism.  The 
general  flabbiness  of  tissue,  which  may  be  brought 
on  by  the  unnatural  confinement  to  chambers,  and 
the  want  of  vigorous  out-of-door  play,  which  city 


66  Sanity  of  Mind 

life  commonly  involves,  may  with  reason  be  sus- 
pected of  contributing  to  the  tendency  to  near' 
sight.  We  must  strive  against  this  tendency,  which 
seems  fatally  inherent  in  our  civilization,  by  abun- 
dant side-light,  good  air,  cool  rooms,  good  print; 
by  discouraging  the  penchant  (literally  such)  for 
stooping  and  getting  close  to  work;  by  frequent 
intermissions,  hearty  play,  and  forbidding  study 
upon  an  empty  stomach. 

The  effects  of  far-sight  have  been  much  debated, 
but  there  is  no  doubt  that  the  eye-strain  it  involves 
is  for  many  children  a  serious  cause  of  nerve  dis- 
order, appearing  in  a  tendency  to  frown  or  twitch 
the  face  muscles,  and  in  frequent  headache ;  a  most 
disturbing  and  even  dangerous  state  for  the  nervous 
system,  which  is  easily  and  at  once  rectified  by  the 
use  of  glasses.  These  should  always  be  fitted  by  a 
trained  oculist. 

Dr.  Myles  Standish  is  in  the  habit  of  saying  in 
an  epigrammatic  way  that  whereas  near-sight  is  a 
case  of  the  child  spoiling  his  eyes,  far-sight  is  a  case 
of  the  eyes  spoiling  the  child.  In  the  former,  a 
vast  deal  can  be  done  to  prevent  increase  of  near- 
sight  by  correcting  abuse  of  the  eye.  In  the  latter, 
glasses  put  an  end  permanently  to  the  nervous 
distress  caused  by  congenital  incorrect  eye-structure. 

4.  The  period  of  adolescence  (of  which  puberty 
denotes  the  initial  point)  is  marked  by  a  very  rapid 
increase  in  physical  size  and  strength  and  mental 
faculty,  with  the  rise  of  a  new  set  of  desires  and 
motives.  Self-feeling  is  apt  to  be  exaggerated. 


Education  67 

There  is  an  awkwardness  and  want  of  harmony  in 
the  use  of  the  new  faculties;  there  is  turmoil  and 
self-contradiction,  uncomprehended  longing,  fluc- 
tuation of  temper  and  purpose,  restlessness  and 
\  recklessness,  in  the  midst  of  which  sexual  impulses 
and  the  religious  feelings  are  prominent  influences. 

In  the  development  of  every  child  there  are 
periods  at  which  the  mind  receives  impressions  with 
extraordinary  avidity.  These  are  the  periods  of  the 
budding  of  new  instincts  and  faculties;  and  the  age 
we  are  describing  is  eminently  of  this  character. 
Within  a  year  or  two  the  dispositon  takes  a  set  in  a 
new  direction,  often  influencing  the  remainder  of 
life.  This  is  the  great  opportunity  of  the  educator 
— the  greatest  in  a  lifetime. 

Puberty  and  adolescence  are  characterized  by 
chlorosis,  defects  in  menstruation,  hysteria,  epi- 
lepsy, and  adolescent  disturbances  of  the  mental 
faculties  in  many  forms,  including  insanity,  which 
is  apt  to  be  of  a  special  type,  partaking  of  the  un- 
steadiness of  the  mental  status  at  that  age. 

The  amount  of  insanity  among  children  is  very 
small,  but  that  among  youths  is  greater  than  is  sup- 
posed. Blandford,1  quoting  the  English  Commis- 
sioners' statistics  for  1888-92,  shows  that  between 
twenty  and  twenty-four  it  is  nearly  as  frequent  as 
at  any  later  age ;  between  fifteen  and  nineteen,  it  is 
about  half  as  frequent  as  that. 

N 


Many  of  these  statements  may  seem  unnecessarily 


technical.     They  are  introduced  under  a  sense  of 

f>  V 

1  Twentieth  Century  Practice  of  Medicine,  vol.  xii.,  p.  15. 


68  Sanity  of  Mind 

the  gravity  of  the  responsibility  which  rests  upon 
those  in  whose  hands  is  placed  the  training  of  such 
a  susceptible  age,  already  a  victim  in  large  numbers 
to  this  terrible  entailment.  It  is  well  worth  while, 
too,  to  have  it  brought  before  our  minds  that  cer- 
tain of  the  affections  of  which  we  have  spoken  are 
closely  allied  to  insanity,  and  that  judicious  treat- 
ment of  them  may  do  much  to  avert  that  issue. 
Briquet  showed  that  hysterical  women  have  eight 
times  as  much  of  nervous  disease  among  their  near 
relations  as  sound  women  do.  Clouston  says  that 
IMH  half  the  cases  of  adolescent  insanity  in  young 
(  women  there  are  hysterical  symptoms  present  at 
some  stage  of  the  disease  or  preceding  it.  The 
inference,  however,  should  not  be  carried  too  far. 

The  relation  of  the  neuroses  to  adolescent  insanity 
has  never  been  thoroughly  studied.  We  are  not 
in  a  position  to  predict  much.  \But  it  may  be  sug- 
gested that  any  deviation  from  the  normal  attitude 
of  the  child's  mind  is  suspicious.  \  The  "  old  " 
child,  the  little  Paul  Dombey,  ma)rbe  unchildlike 
through  the  general  exhaustion  of  frame  due  to  a 
taxed  brain.  A  deficiency  of  the  natural  "  wild- 
ness  "  of  youth  may  suggest  the  possibility  of 
subsequent  derangement,  as  well  as  an  excess  of 
impulsiveness  and  want  of  self-control.  In  general, 
development  of  a  part  of  the  nature,  out  of  relation 
to  the  rest,  is  apt  to  be  morbid. 

Child  mathematicians,  child  musicians,  and  child  poets 
are  rare,  and  we  know  they  are  all  more  or  less  patho- 
logical. I  think  that  development  of  any  faculty  or 


Education  69 

power  in  a  boy  or  girl,  in  a  lad  or  a  maiden  under 
twenty-five,  that  is  premature  in  time,  or  that  is  clearly 
out  of  proportion  to  other  faculties  and  powers,  should 
be  carefully  watched  and  looked  on  with  much  medical 
suspicion.1 

As  regards  the  training  of  neurotic  children,  the 
whole  drift  of  our  argument  is  in  favor  of  a  full  de- 
velopment of  the  bodily  system,  as  against  dwarfing 
or  stunting.  In  taking  means  to  this  end  we  may 
be  sure  that  we  are  in  the  road  which  leads  away 
from  degeneracy.  Modern  investigation  seems  to 
be  leading  straight  away  from  the  antique  notion 
that  the  body  is  the  antagonist  of  the  soul ;  it  stig- 
matizes the  notion  as  deadly  to  the  highest  interests 
of  mental  sanity,  right-mindedness,  and  chastity; 
it  antagonizes  the  view  that  the  puny  are  the  bright 
ones,  and  traces  clear  connections  between  size  of 
body  and  mental  endowments. 

It  becomes  us  to  be  careful  in  our  inferences. 
Certain  tall  races  (Russian,  Germanic,  Celtic)  are  in 
the  lead  to-day  ;  but  the  Romans  were  short,  and  the 
Jews  and  Japanese  now  are.  All  statements  of  size 
should  be  made  relative,  referring  to  the  standard 
of  race  or  family. 

The  relation  between  the  nutrition  and  growth  of 
the  body  and  the  vigor  of  the  brain  is  best  seen  in 
the  case  of  the  feeble-minded.  By  way  of  excep- 
tion, a  few  are  beautiful  and  attractive;  but  as  a 
general  rule  they  are  dwarfish,  ugly,  one-sided,  ir- 
regular and  coarse  in  feature,  awkward  in  gait  and 

1  Clouston,  Neurosts  of  Development,  p.  18. 


70  Sanity  of  Mind 

movement,  and  harsh  in  voice.  The  muscles  are 
usually  weak,  the  fingers  small ;  scrofula  is  common  ; 
they  are  very  susceptible  to  cold ;  one  fifth  are  epi- 
leptic, and  they  often  fail  to  pass  the  half-way  sta- 
tion in  life  for  want  of  vitality.  These  statements 
regarding  physical  degeneration  are  applicable  in 
proportion  to  the  degree  of  the  mental  abasement. 
Dwarfishness  is  eminently  a  trait  of  cretinism. 
Bodily  growth  is  also  checked,  along  with  mental, 
in  the  sporadic  variety  of  cretinism,  termed  myxce- 
dematous  idiocy. 

It  has  been  made  out  in  many  series  of  school 
statistics  that  the  larger  children  are  on  the  whole 
;  more  successful  and  more  advanced  in  their  school 
work  than  the  smaller  ones  of  corresponding  ages. 
The  fact  has  been  denied,  but  I  believe  it  to  be 
sufficiently  established.  Success  in  college  gym- 
nastics is  apt  to  go  along  with  general  success  in 
study.  \Criminals  average  less  in  height  and  weight 
than  the  college  boys ;  those  at  Elmira  (young  men) 
are  about  equal  in  size  to  college  young  women, 
i.  e:,  about  four  inches  shorter  than  college  men.\ 

We  have  in  gymnastics  and  sports  a  means  of 
raising  the  efficiency  of  the  national  power  to  a  de- 
gree of  which  we  have  no  conception.  Before  we 
realize  these  possibilities  through  education  we 
have  two  things  to  do :  first,  to  give  full  time  and 
full  credit  to  gymnastic  work;  and,  second,  to  pro- 
vide rooms,  apparatus,  and  lavatories  fitted  for 
varied  and  fully  developed  work. 

In  England  statistics  show  that  the  upper  classes, 


Education  71 

brought  up  to  sports  as  a  part  of  education,  are 
five  inches  taller  than  the  lower  ranks  in  life.  In 
America  it  is  a  common  observation  that  the  girls 
who  have  been  growing  up  with  athletic  sports  have 
developed  a  taller  race  than  their  predecessors. 
We  have  certainly  this  to  thank  our  sports  for ;  no 
one  to-day  can  say,  as  Catherine  Beecher  said  fifty 
years  ago,  that  she  does  not  know  ten  women 
(among  thousands  of  acquaintances)  who  enjoy 
vigorous  health.1  All  this  brings  good  hope  for  the 
future. 

The  new  movement  in  favor  of  swimming  baths, 
recreation  grounds  and  playgrounds,  and  municipal 
gymnasiums  is  also  very  encouraging. 

No  one  with  natural  feelings  can  help  being  glad 
to  see  children  play.  During  the  hour  of  play  we 
give  nature  her  turn  as  educator.  If  we  grown 
people  were  responsible  for  the  whole  mental  make- 
up of  the  young  folks,  what  a  direful  set  of  prigs 
and  puppets  we  should  have!  Fortunately,  there 
is  extant  among  children  a  great  and  ancient  tra- 
dition, which  has  the  force  of  law,  describing  the 
games  which  their  child-ancestors  played  before 
ABC  was  taught.  These  games  are  well  suited 
to  bring  out  some  of  the  basal  traits  of  character 
and  intellect  —  quick  sight,  dexterity  of  hand, 
agility,  lung-power,  voice,  speed,  endurance,  with 

1  "  I  am  not  able  to  recall,  in  my  immense  circle  of  friends  and 
acquaintances  all  over  the  Union,  so  many  as  ten  married  ladies 
born  in  this  country  and  century,  who  are  perfectly  sound,  healthy, 
and  vigorous." — Letters  to  the  People  on  Health  and  Happiness , 
1855,  p.  129. 


72  Sanity  of  Mind 

love  of  fairness,  self-assertion,  will-power,  social 
instinct,  and  general  experience  of  unveiled  human 
nature. 

It  may  startle  some  to  find  "  lung-power"  in- 
cluded among  evidences  of  character.  But  there  is 
no  bodily  function  which  stands  so  near  the  centre 
of  vitality  as  respiration.  There  is  no  condition  of 
the  human  frame  more  antithetic  to  the  cravings 
of  vice  than  that  of  the  panting  player  with  the 
calls  of  the  game  ringing  in  his  ears,  j  Expanding 
the  chest  —  increasing  the  "vital  index"  of  the 
gymnast '  —  places  the  man  or  woman  on  a  higher 
plane  of  vitality,  which,  it  is  the  contention  of  the 
present  book,  lies  at  the  basis  of  psychic  health.', 

The  child  of  nervous,  "  cultured,"  "  gifted," 
"  artistic  "  parents,  is  likely  to  need  a  strong  bias 
toward  the  physical  side  of  his  education.  Such  a 
child  is  apt  to  have  a  brain  built  on  the  hair-trigger 
principle  —  it  goes  off  too  readily,  shooting  into  in- 
fantile convulsions,  St.  Vitus's  dance,  stuttering, 
bad  dreams,  or  delirium,  as  we  have  just  seen.  For 
many  such  children  the  happiest  lot  would  be  a  sepa- 
ration from  the  nerve-fostering  atmosphere  of  their 
brilliant  parents  during  the  period  of  girlhood  and 
boyhood,  and  assignment  to  some  farm  or  boarding- 
school  where  the  robuster  type  of  life  is  encouraged. 
For  those  who  stay  at  home,  a  scheme  of  tonic 
hygienic  life  must  be  maintained.  They  must  be 

1  The  vital  index  is  the  ratio  of  the  lung-capacity  to  the  body- 
weight,  and  is  considered  the  best  numerical  index  of  a  person's 
general  vigor  and  endurance. 


Education  73 

allowed  all  the  farm  and  fishing  experiences  possible 
in  holidays.  Their  sleeping-rooms  must  be  airy, 
uncarpeted,  cool,  sunny;  their  meals  regular,  fre- 
quent, with  little  or  no  meat  and  a  plenty  of  milk 
up  to  the  age  of  twelve,  with  abundance  of  butter, 
cream,  and  fat,  — no  coffee,  tea,  or  beer,  — and  no 
sweetmeats  except  at  meals;  their  sleep  l  very  long 
(ten  hours  up  to  the  age  of  twelve) ;  their  occupa- 
tions to  comprise  a  great  deal  of  outdoor  play  (or 
walking);  gymnastics  as  a  steady  thing,  with  fen- 
cing, boxing,  riding  horseback,  dancing,  and  choral 
singing;  manual  training  in  sloyd  and  other  work; 
and,  if  possible,  for  an  hour  every  day,  some  useful 
toil  in  the  sweat  of  their  brow — a  privilege  which  it 
is  very  hard  to  secure  for  children  in  cities.  As  for 
schooling,  there  need  be  no  hurry ;  a  child  who  is 
getting  on  in  these  branches  can  afford  to  postpone 
scholastic  work  as  long  as  there  is  any  doubt  of  his 
strength,  say  till  he  is  eight  or  ten  years  old. 

We  owe  much  to  some  of  our  German  contempo- 
raries for  the  emphatic  way  in  which  they  have  de- 
scribed the  traits  of  a  class  of  children  whom  they 
designate  as  "  minderwertig  "  —  a  term  implying 
that  they  are  on  the  whole  lacking  in  power.*  They 
are  not  imbecile  or  insane,  but  are  irregular  in  ways 

1  Dr.  Clement  Dukes  estimates  the  amount  of  sleep  required  by 
children  as  13^  hours  at  the  age  of  5-6,  12  hours  at  8-9,  10  hours  at 
12-14,  and  8£  at  17-19.  Quoted  in  Warner's  Nervous  System  of  Ike 
Child,  p.  124. 

*  See  J.  L.  A.  Koch,  Die  psychopathischen  Minderivertigkeiten, 
1893  ;  J.  Trtlper,  Psychopathische  Minderwertigkeiten  itn  Kindes- 
alter,  1893. 


74  Sanity  of  Mind 

which  prevent  them  from  being  in  a  normal  mental 
state  and  displaying  normal  capacity ;  they  are  com- 
monly said  to  be  hard  to  educate.  They  are  apt  to 
display  a  combination  of  mental  and  moral  weak- 
ness, mutually  interdependent;  as  their  education 
proceeds  they  often  appear  overstimulated,  listless, 
incapable,  or  degenerate,  and  at  last  may  become 
"  spoiled  "  and  depraved.  Irregularities  of  bodily 
structure  are  common.  Many  such  children  are  the 
objects  of  successive  experiments,  each  bringing 
new  failure,  until  at  last  their  mental  and  moral 
opposition  to  rules  makes  them  unendurable  in  civil 
society. 

Among  this  class  the  type  of  "  irritable  weak- 
ness "  is  common.  /  This  is  denoted  by  the  excessive 
sensitiveness  to  painful  impressions,  physical  or 
moral.  To  blame,  loss,  the  parting  or  meeting 
with  friends,  they  respond  with  exaggerated  and 
unhealthy  displays  of  joy  or  grief  which  is  soon  for- 
gotten. They  are  heedless,  fickle,  and  whimsical 
in  thought  and  act.  This  is  a  type  which  produces 
child-suicides.  Sexual  precocity  is  not  uncommon. 
There  is  often  an  appearance  of  precocious  intelli- 
gence and  vivacity,  which  tempts  parents  to  urge 
them  to  study,  but  they  are  very  apt  to  end  in  ex- 
ceeding dullness,  or  even  imbecility. 

These  children  seem  to  lend  themselves  readily 
to  parrot-like  memorizing,  and  as  they  are  easily 
forced  beyond  the  limits  of  their  strength  they  may 
become  mere  volumes  of  "  facts  "  without  the 
power  of  rational,  connected  thinking.  Of  such 


Education  75 

was  the  charming,  sprightly  little  boy  who  in  his 
eighth  year  was  commended  for  his  Latin  exercises, 
but  at  fifteen  could  not  name  a  plant  or  tree  in  the 
garden,  although  very  familiar  with  Linnaeus's  sys- 
tem, and  when  asked  to  estimate  the  height  of  an 
ordinary  chamber  said  "  Sixty  feet."  There  is  a 
glimpse  of  pathos  in  the  story  of  a  boy  in  a  high 
grade  of  Latin  school,  who  "  was  nauseated  with 
verbalism  and  had  utterly  lost  interest  in  study  " ; 
he  was  placed  in  an  asylum  for  "  difficult  "  children, 
and  there  one  morning,  while  sitting  over  his  un- 
touched work,  he  overheard  the  asylum  superin- 
tendent telling  stories  to  the  little  children  in  the 
next  room ;  his  attention  was  drawn,  he  grew  inter- 
ested, then  begged  for  and  read  the  fairy-tales,  and 
from  this  beginning  mental  interests  re-awakened, 
and  in  a  year  he  was  again  doing  a  reasonable  share 
of  work. 

Among  the  "  minderwertig  "  class  (for  which  we 
have  no  better  equivalent  than  "  difficult  children  ") 
a  great  many  cases  of  nervous  breakdown,  nervous 
disease  in  general,  and  occasionally  insanity  doubt- 
less originate,  for  which  the  school  program  cannot 
fairly  be  held  accountable.  Blame  lies,  however, 
with  the  school  government,  in  so  far  as  it  fails  to 
provide  means  for  ascertaining  the  presence  of  such 
children,  and  giving  them  special  attention.  But 
in  view  of  the  official  disregard  of  such  obvious  and 
well  known  matters  as  near  sight  and  deafness  in 
schools,  it  is  doubtless  premature  to  urge  the  adop- 
tion of  measures  to  rescue  these  few  exceptional 


76  Sanity  of  Mind 

children  from  special  dangers.  The  duty  of  picking 
out  such  children  from  the  mass  of  those  who  may 
be  called  normal  is  obvious,  but  school  authorities 
cannot  yet  see  that  it  rests  on  them. 

At  the  risk  of  partial  repetition,  the  following 
succinct  and  emphatic  statement  from  Clouston  l  is 
quoted  as  embodying  the  principles  to  be  followed 
in  bringing  up  the  classes  of  children  just  described: 

A    FEW    GENERAL    CONSIDERATIONS   IN     REGARD    TO    THE 
PREVENTION    OF    THE   NEUROSES   OF   DEVELOPMENT. 

Heredity  is  no  doubt  the  real  predisposing  cause  of 
them  all,  and  the  sole  cause  of  many,  some  of  them 
being  in  certain  cases  inevitable  during  growth  and  de- 
velopment. But  heredity  is  a  question  of  degree  and 
intensity  in  each  case,  and  it  fortunately  needs  in  many 
cases  an  exciting  cause  to  develop  the  diseases  that  are 
its  outcome.  That  opens  up  to  us  a  large  field  of  pre- 
ventive measures  against  the  adolescent  neuroses.  One 
or  two  general  principles  we  are  safe  in  following  as 
making  for  prevention,  j  Build  up  the  bone  and  fat  and 
muscle,  especially  the  fat,  by  means  known  to  us,  during 
the  periods  of  growth  and  development.  \  Make  fresh  air 
the  breath  of  life  to  the  young.  Develop  lower  centres 
rather  than  higher  ones  where  there  is  bad  heredity. 
Don't  give  too  much  flesh  and  nitrogenous  food  during 
growth  and  adolescence,  as  being  special  stimulants  to 
the  higher  cortex,  and  to  the  too  early  development  and 
dominance  of  the  reproductive  functions  and  the  sexual 
nisus.8  Avoid  alcohol  and  nervine  stimulants  absolutely, 

1  Loc.  cit.,  pp.  134,  135. 

1  In  regard  to  sexual  abuses  among  children ,  the  reader  will  find 
references  to  the  opinions  of  several  authorities  in  the  Appendix. 


Education  77 

if  possible.     Do  not  cultivate,  rather  restrain,  the  imagi- 
native and  artistic  faculties  and  sensitivenesses  and  the 
idealisms  generally,  in  the  cases  where  such  tend  to  ap- 
pear too  early  and  too  keenly.     They  will  be  rooted  on 
a  better  brain  and  body  basis  if  they  come  later.     Culti- 
vate and  insist  on  orderliness  and  method  in  all  things. 
The  weakly  neurotics  are  always  disorderly,  unbusiness- 
like, and  unsystematic.     Fatness,  self-control,  orderli-/ 
ness,  are  the  three  most  important  qualities  for  them  to\ 
aim  at. 

The  education  of  the  defective  classes  is  one  of 
the  most  brilliant  achievements  of  the  century,  and 
has  immortalized  the  names  of  Seguin  and  Howe. 
Both  these  men  accomplished  what  seemed  impos- 
sible. The  methods  used  by  them  deserve  the 
study  of  all  teachers  for  the  insight  into  the  funda- 
mentals of  education  they  display.  The  methods 
now  in  use  in  our  schools  for  the  feeble-minded  are 
a  kind  of  magnified  object-lesson  of  the  laws  of 
teaching  young  children.  It  is  from  this  point  of 
view  that  I  think  it  will  be  useful  by  way  of  illus- 
tration to  present  some  of  the  traits  of  the  mental 
life  of  this  class  of  beings. 

Attention,  as  we  know,  lies  at  the  base  of  all 
mental  acquisition,  j  In  the  weak-minded,  nothing 
is  more  characteristic  of  the  whole  class  than  their 
want  of  power  to  fix  their  attention,  or  to  continue 
it.  Serious  matters  must  be  continually  repeated 
to  them  to  make  them  understand.  They  pass 
from  one  subject  to  another  with  the  greatest  ease. 
They  cannot  wait  for  you  to  complete  a  sentence, 


78  Sanity  of  Mind 

but  interrupt  with  a  question,  and  before  you  have 
finished  the  answer  they  interrupt  again.  They 
begin  a  piece  of  work,  but  seem  to  forget  that  they 
have  begun  it  (Peterson).  There  is,  however,  a 
great  difference  in  the  power  of  attention  of  indi- 
viduals, and  upon  this  point  mainly  depends  the 
possibility  of  making  improvement. 

Children  and  idiots  are  alike  in  this,  that  the  vol- 
untary control  of  attention  is  not  strong ;  the  motive 
of  duty,  or  other  high  and  abstract  considerations, 
is  not  available  to  any  great  extent  in  the  beginnings 
of  education.  The  attention  has  to  be  captured  by 
interest ;  and  here  we  see  a  difference  —  the  normal 
child  is  easily  interested,  while  the  idiot  has  to  be 
aroused  by  strong  appeals.  (  Life  is  not  vivid  to 
him.v  His  mental  activity  being  weak,  he  gives  lit- 
tle attention  to  the  impressions  of  the  senses.  His 
senses,  therefore,  appear  generally  weak ;  the  sight, 
hearing,  taste,  or  smell  is  commonly  defective,  while 
the  great  general  sense  of  bodily  touch,  of  heat  and 
cold,  hunger  and  thirst,  and  other  feelings  within 
the  body,  and  indeed  of  pleasure  and  pain  at  large, 
are  markedly  deficient.  The  teacher  is  therefore 
obliged  to  exaggerate,  to  use  loud  tones,  large  ob- 
jects, bright  colors,  and,  if  possible,  models  and 
pictures  of  everything  taught. 

The  feeble-minded  have  to  be  made  more  like 
normal  children  before  they  can  be  put  to  ordinary 
school  work.  They  have  not  that  excess  of  avail- 
able energy  which  works  itself  off  in  play;  they 
have  to  be  roused  by  play,  nay,  first  of  all,  they  must 


Education  79 

be  roused  to  play.  The  teacher  uses  balls,  blocks, 
and  other  implements  as  incentives  to  games  of  mo- 
tion. The  stimulus  given  to  attention  in  handling 
these  toys,  with  cooperation  of  the  muscular  facul- 
ties, associated  furthermore  with  the  gratification  of 
the  sense  of  color  and  form,  the  pleasure  of  suc- 
cessful accomplishment,  and  the  teacher's  sympathy, 
forms  a  brilliant  illustration  of  the  way  in  which 
play  may  be  employed  for  awakening  dormant 
faculties. 

The  acquisition  of  mental  experiences  and  of 
data  relating  to  the  outer  world  through  muscular 
activities  forms  a  large  chapter  in  the  history  of 
man's  development.  It  forms  the  chief  occupation 
of  the  baby — and  of  the  beginners'  class  in  feeble- 
minded children. 

The  first  story  of  the  educational  fabric  is  built  of  // 
muscular  activities.' 

There  is  a  very  intimate  relation  between  what  a 
feeble-minded  child  knows  and  what  he  can  do  with  his 
hand.  And  inversely,  mental  development  is  almost 
always  preceded  by,  and  proportionate  to,  increase  in 
manual  dexterity.  Hand  training  in  great  variety  forms 
an  important  part  of  the  daily  exercise  of  every  pupil 
according  to  his  ability.  [Fernald.] 

A  study  of  moral  traits  shows  in  a  rather  startling 
way  the  possibilities  which  lie  within  the  power  of 
degeneration  to  produce.  I  refer  to  the  class  of 
moral  imbeciles,  of  whom  one  finds  specimens 
in  every  institution, — persons  whose  incapacity  of 


8o  Sanity  of  Mind 

acting  from  moral  considerations  contrasts  strikingly 
with  apparently  good  general  endowments.1  It 
may  be  that  this  monstrosity  of  character  is  some- 
thing comparable  (in  the  inverse  direction)  with  the 
excessive  development  of  a  single  talent  in  the 
midst  of  general  feebleness  of  mind  which  we  see  in 
the  case  of  the  idiots  savants. 

The  superintendent  of  the  Elwyn  Training  School* 
makes  the  following  statement : 

It  is  a  mournful  conclusion  that  has  been  reached 
after  twenty  years'  experience,  that  in  every  institution 
of  this  kind,  and  probably  to  a  far  greater  extent  in  our 
refuges  and  charity  schools,  there  exists  a  small  class  of 
children  to  whom  the  offices  of  a  school-room  should 
not  be  applied.  These  are  the  so-called  moral  im- 
beciles, or  juvenile  insane,  who  are  often  precocious  in 
their  ability  to  receive  instruction,  but  whose  moral 
infirmity  is  radical  and  incurable.  The  early  detection 
of  the  class  is  not  difficult.  They  should  be  subjects  for 
life-long  detention.  Their  existence  can  be  made  happy 
and  useful ;  and  they  will  train  into  comparative  docility 
and  harmlessness,  if  kept  under  a  uniform,  temperate, 
and  positive  restriction.  The  school-room  fosters  the 
ill  we  would  cure.  In  teaching  them  to  write,  we  give 
them  an  illimitable  power  for  mischief.  In  educating 
them  at  all,  except  to  physical  labor,  we  are  adding  to 
their  armament  of  deception  and  misdemeanor. 

1  The  word  ' '  apparently  "  should  be  emphasized.  Some  degree 
of  mental  inequality  or  imperfection  is  associated  with  the  moral 
deficiency  as  a  rule. 

8  Quoted  by  Dr.  Kerlin  in  Thirty-third  Report,  from  an  earlier 
report. 


Education  81 

I  quote  the  following  from  a  letter  from  Dr.  Fer- 
nald: 

The  true  moral  imbecile  is  undoubtedly  incurable. 
In  institutions  for  the  feeble-minded  we  seldom  see  the 
real  moral  imbecile — he  is  more  often  found  in  reforma- 
tories and  prisons,  sometimes  in  schools  and  colleges.  I 
mean  the  cases  with  little  or  no  intellectual  defect,  per- 
haps brighter  than  the  average,  and  with  all-round  moral 
defects,  not  simply  dishonesty,  licentiousness,  etc.  A 
bad  and  troublesome  imbecile  is  not  a  moral  imbecile, 
as  the  laity  are  apt  to  believe. 

As  regards  the  general  moral  status  of  the  feeble- 
minded, they  are,  naturally,  easily  led  astray  in  the 
direction  of  wrong-doing,  of  the  consequences  of 
which  they  have  no  just  idea.  They  may  thus  com- 
mit the  most  heinous  crimes.  They  are,  however, 
very  rarely  malicious  by  nature.  Their  status  is 
that  of  imperfect  evolution.  They  require  to  be 
taught  lessons  in  decency,  and  they  require  special 
management  at  the  onset  of  puberty.1 

With  all  this,  there  is  something  which  touches 
the  observer  with  wonder  and  sympathy.  When 
kindly  treated  and  subjected  to  wakening  influences, 
there  is  no  class  of  persons  that  displays  such  grati- 
tude and  affection  as  the  feeble-minded.  I  It  would 
seem  that  the  instinct  of  mutual  attachment  is  one 
of  the  most  basic  elements  of  our  nature.  At  all 
events,  their  teachers  feel  their  efforts  rewarded 
more  openly  than  is  the  case  in  schools  of  sound 
children. 

>W.  W.  Ireland,  Mental  Affections  of  Children,  1898. 


82  Sanity  of  Mind 

Ireland  notes  their  capacity  of  receiving  elemen- 
tary religious  instruction.  Fernald 

has  known  many  undoubted  imbeciles  who  seemed  to 
have  a  good  idea  of  the  religious  standard  of  their 
people,  and  who  seemed  to  possess  religious  feeling  as 
genuine  as  that  of  their  people.  The  emotional  side  of 
religion  appeals  to  them  very  much  as  it  does  to  the 
plantation  negro. 

The  picture  of  the  status  of  the  defective  is  a 
gloomy  one;  but  the  gloom  is  relieved  by  the 
thought  that  want  of  development  is  the  essential 
cause,  and  that  development  (within  the  bounds 
which  Nature  sets  for  each  individual)  is  in  the 
teacher's  hands.  The  description  represents  only, 
the  untrained  child.  The  results  attained  by  train- 
ing affect  not  their  intellect  alone,  but  their  entire 
moral  condition,  and  especially  their  habitual  be- 
havior. From  being  pests  in  their  families  and 
neighborhood,  they  may,  in  a  large  part  of  the 
cases,  be  made  peaceable  and  happy  members  of 
a  family  order. 

Ireland '  points  out  that  a  steady  diminution  in 
the  prevalence  of  goitre  and  cretinism  has  been 
going  on  for  at  least  thirty  years  in  France,  Switzer- 
land, and  Germany  ;  which  seems  most  probably 
owing  to  the  increase  in  the  well-being  and  comfort 
of  the  people  who  live  in  the  endemic  districts,  and 
their  more  careful  attention  to  cleanliness  and 
hygiene. 

1  Mental  Affections  of  Children,  p.  228. 


Education  83 

Another  direction  in  which  new  hope  has  been 
granted  to  humanity  is  the  recent  successful  treat- 
ment of  certain  sporadic  cases  of  cretinism  (myxce- 
dematous  idiocy)  by  feeding  with  small  portions  of 
the  thyroid  gland  of  the  sheep.  The  disease  is  be- 
lieved in  these  cases  to  be  due  to  the  absence  of 
the  thyroid  gland  in  the  patient,  with  the  conse- 
quent lack  of  a  certain  secretion  which  is  requisite 
for  the  nutrition  of  the  brain  and  of  the  whole 
organism.  A  remarkable  gain  in  bodily  growth 
and  intelligence  has  been  found  to  occur  during 
the  progress  of  this  treatment.1 

Outside  of  the  class  returned  in  statistics  as  feeble- 
minded there  exists  a  much  larger  class  (perhaps  five 
in  a  thousand)  of  "  backward  "  children,  a  type 
with  which  all  primary  teachers  are  familiar,  who 
are  so  deficient  as  to  be  incapable  of  profiting  by 
ordinary  school  methods.  They  constitute  a  dis- 
tinct type,  differing  from  the  grosser  types  only  in 
degree  of  defect ;  they  display  all  the  cardinal  feat- 
ures of  imbecility  in  a  lesser  degree.  Few  classes 
are  without  some  such  specimen,  hopeless  under 
existing  conditions,  yet  fondled  and  defended  by 
parental  love  which  can  see  no  inferiority  in  its  own 
offspring.  A  movement  for  the  education  of  these 
children  in  special  classes  under  trained  instructors 
has  just  begun  in  the  United  States,  which  up  to  the 
present  includes  the  cities  of  Providence,  Worcester, 
Springfield,  Boston,  Philadelphia,  and  Chicago. 

Is  there  a  distinct  line  of  division  between  the 

1  Mental  Affections  of  Children,  pp.  237-249. 


84  Sanity  of  Mind 

defective  and  the  normal  child  ?  or  do  the  classes 
grade  imperceptibly  into  each  other  ?  The  question 
may  be  put  in  another  way,  as  follows :  Should  a  skil- 
ful and  experienced  observer  be  able  to  say,  in  every 
case  which  he  is  allowed  to  study,  "  This  child  is 
(or  is  not)  likely  to  develop  into  an  imperfect  adult, 
and  its  progeny  is  likely  to  be  imperfect  "  ?  I  am 
inclined  to  answer  the  latter  question  in  the  affirma- 
tive. 

There  are  numbers  of  cases  which  deceive  a  super- 
ficial observer;  of  these  I  do  not  speak.  Neither 
can  one  deny  the  imperfectness  of  our  present  means 
of  diagnosis  for  some  cases.  There  is,  however,  a 
very  important  distinction,  which  we  can  all  under- 
stand, between  the  merely  dull  or  slow  child  of  nor- 
mal type,  and  the  morbidly  deficient  child.  Such 
is  the  view  of  J.  Batty  Tuke,  who  finds  that  the  two 
conditions  do  not  merge  gradually  one  into  the 
other.  The  lowest  of  the  healthy  may  be  extremely 
stupid ;  the  highest  imbeciles  may  in  certain  ways 
appear  superior  to  them,  but  the  former  class  are 
simply  uniformly  dull,  while  the  latter  stand  in 
marked  contrast  to  them  by  their  irregularity  of 
mental  conformation.1  This  point  is  well  brought 
out  in  the  Report  of  the  Special  Committee  of  the 
Charity  Organization  Society.*  Children  of  this 
class  are  very  imitative,  may  have  remarkable . 
memories,  and  may  appear  clever,  but  are  deficient  \ 
in  reasoning  power,  feeble  in  will,  or  unable  to  j 

1  Article  on  "  Insanity,"  Encyclopedia  Britannica. 

9  The  Feeble-Minded  Child  and  Adult,  London,  1893,  p.  7. 


Education  85 

appreciate  moral  distinctions  —  in  short,  they  are 
naturally  termed  "  deficient  "  by  those  who  have  to 
do  with  them;  they  are  the  "  irregular  "-minded, 
and  constitute  our  great  difficulty.  They  need  the 
care  of  skilful  teachers  trained  in  special  kindergar- 
ten methods.  The  merely  slow  children  do  not  be- 
long with  them,  and  are  brought  up  into  line  by  a 
certain  amount  of  patient  helping.  Both  classes 
are  liable  to  degenerate  morally,  physically,  and  \ 
intellectually  if  neglected. 

The  success  of  a  teacher  must  greatly  depend  on 
his  knowledge  of  the  individual  character  and  mind 
of  his  pupils,  a  first  requisite  to  which  is  the  limita- 
tion of  the  size  of  classes.  I  give  a  hearty  assent  to 
the  protests  which  are  being  raised  by  some  of  the 
foremost  of  our  educators  against  the  present  me- 
chanical system,  which,  like  a  factory  boss,  assigns 
to  each  teacher  as  many  looms  (^videlicet,  pupils)  as 
she  is  physically  able  to  control — a  system  based 
upon  the  assumption  that  pupils  are  practically  alike 
for  the  purposes  of  the  school-room.  Better  assume 
that  no  two  are  alike. 

The  system  presupposes  that  the  children  are 
normal.  As  a  matter  of  fact,  there  are  few  that  can 
run  together  on  a  course  of  high  and  inflexible  re- 
quirement ;  the  standard  for  the  best  quarter  of  the 
class  is  not  normal  for  the  rest.  These  arguments 
against  large  classes  are  too  well  known  to  need  sup- 
port from  me.  Their  force,  however,  is  very  much 
strengthened  when  we  regard  the  individual  pupils 
as  one  and  all  subject  to  possible  deviation  from 


86  Sanity  of  Mind 

normal  development  into  nervous  disorders  of  all 
degrees  of  gravity,  and  to  numerous  and  serious 
defects  of  physical  endowment,  which  in  the  present 
crowded  state  of  classes  pass  perforce  unnoticed  or 
ill-understood  ;  the  effects  of  which  appear  not  only 
in  injury  to  individuals,  but  in  the  hampering  of 
the  general  progress  of  a  class. 

Defects  of  hearing  and  sight  are  so  common  in 
school-children  that  one  would  suppose  that  a  teach- 
er's mind  would  be  on  the  alert  to  discover  and  pro- 
vide for  cases.  Experience  shows  that  this  is  not 
so.  /  Class  work  engrosses  all  the  powers  of  the 
teacher./  The  investigations  of  Dr.  C.  J.  Blake  and 
others  have  shown  that  deafness  is  very  often  over- 
looked, or,  if  noticed,  it  is  apt  to  be  thought  that  the 
child  is  stupid.  A  case  was  recently  mentioned  to 
me  in  which  the  child  was  pointed  out  as  a  fit  sub- 
ject for  a  special  class  (i.  e.,  a  class  of  feeble-minded 
children),  when  absolutely  all  that  ailed  the  girl  was 
that  she  was  exceedingly  deaf. 

In  the  experience  of  ophthalmic  surgeons,  it  is  excep- 
tional to  meet  with  a  child  suffering  from  defective  vision 
who  has  not,  before  the  defect  was  discovered,  been 
repeatedly  and  systematically  punished  by  teachers  or 
schoolmasters  for  supposed  obstinacy  or  stupidity.  The 
very  reverse  of  this  practice  is  that  which  ought  to  obtain ; 
and  apparent  obstinacy  or  stupidity  should  lead,  from 
the  first,  to  the  question,  "  Can  he  see  perfectly  ?  "  * 

Teachers  are  less  to  blame  for  such  occurrences 

1  R.  Brudenell  Carter,  Eyesight,  Good  and  Bad,  1880,  p.  185. 


Education  87 

than  appears  at  first  sight.  They  have  learned  at  a 
normal  school  the  elements  of  physiology  and  psy- 
chology, among  a  vast  number  of  other  subjects 
whose  importance  is  made  to  appear  overshadowing ; 
but  the  bearing  which  these  doctrines  have  upon 
their  daily  school  duties  is  not  impressed  upon  their 
minds  by  practice.  There  is  no  opportunity  for 
practice  until  they  enter  upon  school  duties.  The 
young,  necessarily  inexperienced  new  teacher  finds, 
as  a  rule,  no  support,  no  practical  guidance,  in  mat- 
ters hygienic;  her  function  as  a  hygienist  is  not 
conceived  of  by  those  who  employ  her,  and  she  has 
mainly  to  rely  on  her  own  unaided  common-sense  for 
direction. 

Mental  incapacity,  readily  appreciated  by  teach- 
ers, is  seldom  recognized  by  parents,  and  parental 
pride  is  often  a  cause  of  great  injury  by  preventing 
a  child  from  being  assigned  to  suitable  special 
classes.1  Injustice  is,  however,  sometimes  done  in 
the  other  direction.  There  is  a  class  of  sound  but 
very  slow  intelligences  which  are  perfectly  amenable 
to  educative  processes,  but  are  unfitted  for  ordinary 
class  work.  One  of  the  most  satisfactory  boys  I 
ever  knew  was  one  of  whom,  at  the  age  of  twelve, 
the  neighbors  spoke  with  reservation  as  "  so  dull  " ; 
but  to  one  who  knew  him,  his  integrity,  docility, 
freshness  and  simplicity  of  interest,  and  fixity  of 

1  "I  have  several  times  been  consulted  by  governesses  in  the 
difficult  and  painful  position  of  having  undertaken  the  education  of 
an  imbecile  child,  whom  the  mother  refused  to  admit  as  being  want- 
ing in  intelligence." — Ireland,  Mental  Affections  of  Children,  p.  355. 


88  Sanity  of  Mind 

attention  were  most  encouraging,  and  his  begin- 
nings in  Latin,  though  made  at  half-speed,  were 
thoroughly  enjoyable  to  teacher  and  taught.  Here 
were  the  essentials  of  a  sound  mental  constitution, 
with  a  constitutional  slowness  which  had  made  him 
unsuccessful  in  his  classes.  A  child  with  such  men- 
tal traits  (to  which  I  ought  to  add  a  fine  physique) 
is  not  to  be  classed  for  a  moment  with  defective 
children ;  ' '  superior  ' '  would  be  a  better  designation. 
A  cause  of  impairment  of  mental  power  in  chil- 
dren deserves  mention  in  this  connection,  as  being 
never  understood  by  parents,  and  only  quite  re- 
cently known  to  surgeons.  I  refer  to  the  presence 
I  of  adenoid  growths  in  the  upper  throat  and  the  back 
passage  of  the  nose.  The  trouble  commonly  be- 
gins in  very  early  childhood;  it  continues,  the  child 
seems  to  have  a  chronic  tendency  to  colds,  becomes 
a  mouth-breather,  grows  deaf,  sleeps  badly  and  with 
distressing  difficulty  of  breathing,  has  a  stuffy,  thick 
voice,  and  is  apparently  stupid  and  unable  to  attend 
to  study.  Removal  of  these  growths  is  performed 
by  a  simple  and  safe  operation,  very  soon  after 
which,  to  the  gratification  and  astonishment  of  par- 
ents and  teachers,  the  children  hitherto  sluggish 
and  dull  of  comprehension  make  rapid  progress, 
and  their  comrades  soon  cease  to  make  a  laughing- 
stock of  them.  The  affection  is  not  confined  to 
little  children ;  I  am  acquainted  with  a  young  lady 
who  went  through  the  operation  at  the  age  of  four- 
teen with  brilliant  results.  The  hearing  is  usually 
restored  at  the  same  time. 


Education  89 

The  occurrence  of  insanity  in  children  has  been 
already  mentioned  (page  67).  For  a  description  of 
the  forms  assumed  the  reader  is  referred  to  such 
special  works  as  Dr.  Charles  K.  Mills's  article  in 
The  American  Text-Book  of  Diseases  of  Children. 
Our  present  purpose  will  be  satisfied  by  noticing 
certain  border-line  affections  which  have  a  special 
interest  for  educators,  comprising  morbid  or  immoral 
propensities  or  impulses,  with  the  "  phobias  "  else- 
where described  (see  page  14).  These  traits  are 
usually  traceable  to  morbid  heredity  in  some  form. 
It  is  of  importance  that  the  fact  be  recognized  that 
morbid  fears  and  doubts,  haunting  apprehensions  of 
an  insane  type  in  children,  are  rarely  due  to  overwork 
and  fatigue  at  school,  as  is  frequently  supposed ; 
they  are  cases  (as  Mills  says)  of  the  class  referred  to 
by  Oliver  Wendell  Holmes,  the  cure  of  which  should 
have  been  begun  two  hundred  years  ago.  It  is  also 
important  to  bear  in  mind  that  there  are  large  pos- 
sibilities of  improvement  and  of  averting  insane  ten- 
dencies by  a  sound,  wholesome  bringing  up. 

The  question  of  over-study  in  the  schools  is  closely 
connected  with  the  foregoing. 

To  a  considerable  extent,  the  injury  which  delicate 
children  receive  in  school  is  due,  not  to  over-study, 
,  but  to  an  ill-arranged  course  of  study.  But,  with  all 
allowance  for  this  fact,  there  is  indubitably  need  for 
a  revision  of  the  quantitative  basis  of  the  day's 
work,  as  well  as  of  the  character  of  the  child's  school 
occupations. 


90  Sanity  of  Mind 

The  phenomena  of  mental  fatigue  have  recently 
been  studied  in  a  scientific  way,  with  results  which 
seem  to  show  a  rather  rapid  exhaustion  of  the  powers 
during  school  work.  Something  more  definite  is 
greatly  needed  as  regards  the  desirable  or  permis- 
sible number  of  hours  of  study,  the  frequency  and 
length  of  intermissions,  and  the  distribution  of  the 
work  among  different  parts  of  the  day.  We  may, 
however,  safely  recommend  an  hourly  intermission ; 
two  sessions  where  practicable ;  alternating  between 
studies  of  different  sorts;  assignment  of  manual 
operations  to  the  afternoon.  Swedish  or  other 
gymnastics  of  a  sort  requiring  close  attention  and 
obedience  must  not  be  classed  as  a  recreative 
agency.O 

We  know  a  good  deal  about  mental  overwork  in 
a  general  way,  but  it  is  difficult  to  give  a  rule  which 
will  serve  to  determine  for  each  case  the  point  where 
healthy  fatigue  becomes  hurtful.  We  can  say, 
however,  that  if  the  sleep  is  disturbed  or  insuffi- 
cient, the  appetite  poor,  especially  the  appetite  for 
breakfast,  the  temper  irritable  or  altered,  there  is 
something  wrong  which  must  be  ascertained  and 
rectified.  It  does  not  by  any  means  follow  that  the 
school  work  is  the  cause  of  the  trouble  in  a  given 
case. 

/  It  is  an  important  sign  if  a  child  shows  excessive 
susceptibility  to  fatigue  under  conditions  of  ordi- 
nary work.  )  Such  children  must  be  watched ;  the 
trait  is  doubtless  [Kraepelin]  one  of  the  indications 
of  degeneracy  (or  perhaps  a  better  expression  is 


Education  91 

constitutional  weakness),  and  may  be  a  forerunner 
of  severe  neurosis  and  psychosis  in  later  life.  It  is 
suggested  by  Kraepelin  that  the  children  ought  to 
be  sorted  out  into  groups  according  to  their  degree 
of  resistance  to  fatigue.  The  institution  of  special 
classes  for  the  backward  children  will  doubtless  soon 
become  general;  and  after  this  is  systematically 
done,  it  will  be  easy  to  divide  each  class  into  an 
upper  and  a  lower  section  under  the  single  regular 
teacher. 

There  is  no  doubt  that  a  considerable  part  of  the 
breakdowns  occurring  among  students  are  due 
to  constitutional  (i.  e.,  hereditary)  weakness,  insuffi- 
cient stamina.  Where  there  is  evidence  that  a 
school  is  conducted  with  an  intelligent  regard  to  the 
principles  of  mental  health,  the  occurrence  of  a 
breakdown  in  the  case  of  an  individual  pupil  should 
lead  us  to  look  for  a  predisposition  in  his  case. 

It  would,  however,  give  a  very  false  impression  if 
we  dismissed  the  matter  of  overpressure  in  schools 
with  these  remarks.  There  is,  and  has  been  for  a 
long  time,  abundant  evidence  of  the  existence  of 
such  abuses.  The  following  citation  from  a  leader 
in  English  psychiatry  gives  most  important  testi- 
mony.1 

The  psychological  mischief  done  by  excessive  cram- 
ming both  in  some  schools  and  at  home  is  sufficiently 
serious  to  show  that  the  reckless  course  pursued  in  many 
instances  ought  to  be  loudly  protested  against.  As  I 
write,  four  cases  come  to  my  knowledge  of  girls  seriously 

1  Tuke,  Insanity  in  Ancient  and  Modern  Life,  pp.  no,  1 12. 


92  Sanity  of  Mind 

injured  by  this  folly  and  unintentional  wickedness.  In 
one,  the  brain  is  utterly  unable  to  bear  the  burden  put 
upon  it,  and  the  pupil  is  removed  from  school  in  a  highly 
excitable  state;  in  another,  epileptic  fits  have  followed 
the  host  of  subjects  pressed  upon  the  scholar;  in  a  third, 
the  symptoms  of  brain  fag  have  become  so  obvious  that 
the  amount  of  schooling  has  been  greatly  reduced;  and 
in  a  fourth,  fits  have  been  induced  and  complete  prostra- 
tion of  brain  has  followed.  These  cases  are  merely  illus- 
trations of  a  class,  coming  to  hand  in  one  day,  familiar 
to  most  physicians.  The  enormous  number  of  subjects 
which  are  forced  into  the  curriculum  of  some  schools 
and  are  required  by  some  professional  examinations, 
confuse  and  distract  the  mind,  and  by  lowering  its 
healthy  tone  often  unfit  it  for  work.  While  insanity 
may  not  result  directly  from  this  stuffing,  and  very  likely 
will  not,  exciting  causes  of  mental  disorder  occurring  in 
later  life  may  upset  a  brain  which,  had  it  been  subjected 
to  more  moderate  pressure,  would  have  escaped  un- 
scathed. Training  in  the  higher  sense  is  forgotten  in 
the  multiplicity  of  subjects,  originality  is  stunted,  and 
individual  thirst  of  knowledge  overlaid  by  a  crowd  of 
theories  based  upon  yet  unproved  statements.  .  .  . 

The  master  of  a  private  school  informs  me  that  he  has 
proofs  of  the  ill-effects  of  overwork  in  the  fact  of  boys 
being  withdrawn  from  the  keen  competition  of  a  pub- 
lic-school career  which  was  proving  injurious  to  their 
health,  and  sent  to  him,  that  they  might,  in  the  less 
ambitious  atmosphere  of  a  private  school,  pick  up  health 
and  strength  again.  He  refers  to  instances  of  boys  who 
had  been  crammed  and  much  pressed  in  order  that  they 
might  enter  a  certain  form  or  gain  a  desired  exhibition 
having  reached  the  goal  successfully,  and  then  stagnated. 


Education  93 

He  says  that  the  too  extensive  curriculum  now  demanded 
ends  in  the  impossibility  of  doing  the  work  thoroughly 
and  well. 

Cramming  for  examinations  to  enter  the  English 
civil  service  is  a  common  and  ruinous  practice ;  and 
to  judge  from  German  testimony  the  same  evil  pre- 
vails to  a  large  extent  in  Germany  among  young 
men  who  wish  to  pay  their  whole  military  debt  by 
entering  the  army  as  one-year  volunteers,  a  privilege 
which  implies  passing  a  severe  examination. 

The  German  system  of  education — or,  rather,  the 
Continental — has  of  late  years  been  attacked  by 
hygienists  in  so  determined  and  persistent  a  manner 
that  the  contest  took  the  name  of  the  "  Ueberbiir- 
dungsfrage,"  or  the  Overwork  Question.  The  con- 
ditions to  which  children,  especially  those  of  the 
better  classes,  were  subjected  all  over  civilized  Eu- 
rope were  shocking  in  their  excess  of  study-time, 
deprivation  of  play,  and  deficiency  of  light  and  air. 
Some  of  the  most  striking  proofs  of  prevalence  of 
invalidism  among  young  people  have  been  published 
in  an  official  report  upon  the  schools  of  Denmark 
and  Sweden  by  Key  and  Hertel.  There  is  now  a 
strong  current  in  favor  of  relieving  the  excess  of 
scholastic  toil.  One  of -the  quaintest  products  of 
German  earnestness  in  this  reform  is  to  be  seen  in 
the  existence  of  large  tracts  of  land  in  the  neighbor- 
hood of  a  number  of  their  cities,  set  aside  for  school- 
play,  to  which  the  children  are  conducted  by  classes 
at  stated  times,  and  are  taught  how  to  play  ball,  tag, 
and  other  more  complicated  games  it  Vanglaise  by 


94  Sanity  of  Mind 

their  regular  teachers,  who  have  been  obliged  them- 
selves to  "  cram  up  "  for  the  occasion. 

In  America  (United  States  and  Canada)  there  is 
a  general  feeling  in  favor  of  confining  school  hours 
to  a  reasonable  limit,  and  of  forbidding  the  assign- 
ment of  home-lessons  to  young  children.  In  our 
country  the  question  of  overwork,  merely  as  re- 
gards the  amount  of  time  devoted,  is  practically 
settled  among  intelligent  educators.  Of  more 
direct  importance  just  now  seems  to  be  the  ques- 
tion of  hunger.  It  has  grown  the  fashion  to  concen- 
trate all  the  school  work  between  the  hours  of  8.30 
and  1.30,  which  is  a  convenience,  but  which  puts 
the  food-question  all  out  of  joint. \  I  recall  the 
pained  expression  with  which  the  head  of  a  large 
private  day-school  spoke  to  me  of  the  injury  which 
this  arrangement  appeared  to  be  doing  in  her  own 
school,  going  so  far  as  to  say  that  "  the  last  hour 
of  the  morning  is  merely  a  spurring  on  of  the  ex- 
hausted—  is  practically  time  thrown  away."  The 
continued  stress  has  been  greatly  relieved  by  a 
proper  hot  luncheon  served  in  the  middle  of  the 
forenoon  in  the  case  of  the  Pratt  Institute  and  the 
Boston  high  schools.  I  am  told  by  headmasters 
of  grammar  schools  that  their  .teachers  are  all  in- 
structed to  look  out  for  children  who  come  without 
breakfast,  and  in  such  cases  always  to  send  them 
home. 

In  what  remains  of  this  chapter  I  wish  to  consider 
some  of  the  mental  faculties  which  are  or  should  be 


Education  95 

objects  of  a  teacher's  care,  and  to  point  out  how 
the  teacher's  work,  broadly  conceived,  may  im- 
port into  the  mind  the  elements  of  vigor,  stability, 
and  capacity  to  resist  stress  or  shock. 

In  this  matter  I  think  we  may  draw  valuable  hints 
from  the  new  and  growing  science  of  Child-Study. 
It  is  altogether  beyond  our  purpose  to  give  an  ac- 
count of  the  growth  of  this  remarkable  movement. 
Its  object  is  to  gauge  the  faculties  and  tastes  of 
natural  children  at  different  ages  by  all  sorts  of  tests, 
direct  and  otherwise.  On  the  physiological  side  it 
gives  us  estimates  of  the  mental  fatigue  induced  by 
study  in  children,  and  the  relations  between  bodily 
and  mental  fatigue,  or  between  study  and  gymnas- 
tics. The  laws  of  growth  and  development  form 
another  section  of  its  work.  It  has  studied  the 
development  of  the  faculties  in  earliest  infancy ;  and 
in  older  children  it  has  given  us  striking  presenta- 
tions of  the  natural  history  of  imagination,  fear, 
anger,  affection,  the  social  instinct,  religion,  and 
other  basal  elements  of  human  nature.  In  the 
pedagogical  way  it  has  furnished  a  great  many  illus- 
trations of  the  preferences  of  children  for  this  or 
that  subject  of  study,  or  kind  of  amusement  or 
play. 

The  greater  part  of  adults  lose  even  the  memory 
of  their  childish  habits  of  mind.  Middle  life,  with 
its  growing  preference  for  generalization,  tempts 
to  the  establishment  of  theories,  too  often  subjec- 
tive in  their  basis,  and  the  most  devout  worshipper 
at  the  shrine  of  childhood  is  apt  to  do  the  most 


96  Sanity  of  Mind 

mischief  by  interpolating  his  own  traits  and  mental 
habits  into  the  picture  he  draws  of  infancy.  We 
"  read  our  own  thoughts  into  "  the  acts  of  children. 

On  the  other  hand,  it  is  found  that  the  average 
young  woman  in  normal  schools  is  in  need  of  being 
reminded  of  the  very  existence  of  children — tiny  yet 
important  beings  walking  in  the  shadow  of  forest- 
like  systems  and  psychologies,  yet  visible  even  to 
the  naked  eye  if  one  will  but  get  down  off  one's 
high  horse  for  a  moment.  One  school  of  child- 
study  has  taken  the  sensible  course  of  asking  the 
students  to  notice  anything  whatever  about  any 
children  they  see ;  and  most  remarkable  revelations 
have  come  from  this — one  girl  has  discovered  that  if 
you  smile  at  a  little  child  it  will  smile  back,  and  so 
on — the  result  being  to  show  the  budding  teacher 
that  her  future  pupils  have  character  as  well  as 
mind, — in  fact,  are  really  persons  of  a  rather  extraor- 
dinary variety  of  type,  and  in  no  wise  machines 
for  grammar  grinding. 

For  those  interested  in  child-study  it  will  be  use- 
ful to  know  of  Mr.  Wilson's  excellent  Bibliography 
of  Child-Study,  published  in  1898.  Frederic  Burk 
has  a  very  complete  article,  entitled  "  Growth  of 
Children  in  Height  and  Weight,"  in  the  American 
Journal  of  Psychology,  vol.  ix.,  No.  3,  April,  1898, 
with  a  full  bibliography,  summing  up  all  the  princi- 
pal results  in  this  branch  of  child-study.  Mac- 
Donald's  Experimental  Study  of  Children,  issued  in 
1899  by  the  U.  S.  Bureau  of  Education,  with  an 
extensive  series  of  synopses  and  reports  of  the 


Education  97 

work  of  various  observers,  covers  the  whole  field. 
The  name  of  Dr.  Francis  Warner  of  London  is  well 
known  in  connection  with  the  examination  of  vast 
numbers  of  school-children.  Among  his  numerous 
works  I  may  mention:  The  Study  of  School-Children 
and  their  School  Training ;  Mental  Faculty ;  and 
one  which  has  just  appeared  on  The  Nervous  System 
of  the  Child,  its  Growth  and  Health  in  Education, 
which  is  professedly  an  exponent  of  the  methods  of 
child-study  in  this  direction.  Dr.  Warner  has  given 
much  attention  to  the  visible  signs  of  neurotic  con- 
ditions in  school-children,  and  has  endeavored  to 
place  the  subject  within  the  reach  of  teachers. 

Too  great  emphasis  cannot  be  laid  upon  the  sub- 
ordination of  scholastic  interests  to  those  of  a  physi- 
cal order  in  children  of  nervous  tendencies,  or  who 
are  precocious  or  one-sided  in  their  development. 
Nevertheless,  there  is  a  point  of  view  from  which 
the  strictly  mental  training  becomes  of  the  highest 
importance  for  such  children ;  I  mean  the  fact — for 
such  I  believe  it  to  be  —  of  the  superior  resistance 
and  stability  of  the  well-trained  brain,  as  compared 
with  the  unschooled  and  neglected. 

A  disused  organ  or  faculty  is  very  apt  to  become 
a  diseased  organ  or  faculty.  \  The  presumption  is  in 
favor  of  the  use  of  any  normal  faculty,  rather  than 
its  neglect.  Nothing  is  more  typical  of  a  degener- 
ated organism  than  the  suppression  of  a  part  of  its 
organs  or  functions;  while  the  undegenerate  being 
of  noble  type  is  characterized  by  symmetry  of  form 
and  fulness  of  development  in  all  parts.  Analogy 


98  Sanity  of  Mind 

leads  us  to  infer  that  the  highest  type  of  mind 
equally  with  that  of  body  is  that  which  is  well- 
rounded  and  all-sided.  That  a  mind  allowed  to  run 
to  waste  is  fruitful  soil  for  vice  and  mental  disorder 
to  spring  up  in,  is  a  truism  for  those  familiar  with 
crime  and  insanity. 

The  health  of  each  separate  faculty  and  the  col- 
lective health  of  the  organism  (body  and  mind)  are 
best  promoted  by  first  building  the  physical  and 
anatomical  structure ;  second,  by  waiting  till  Nature 
wakes  up  each  faculty  in  the  child ;  and  third,  by  a 
vigorous  and  adequate  training  given  to  the  faculty, 
when  ready  for  the  task,  and  no  sooner.  The  dan- 
ger of  premature  action  is  greater  than  that  of  post- 
ponement. But  the  neglect  to  use  the  right  mo- 
ment involves  a  loss,  not  easily  recovered,  perhaps 
never.  The  large  number  of  uneducated  persons 
found  among  the  criminal  classes  points  a  moral 
here. 

Overtraining,  unfortunately,  is  an  exceedingly 
common  thing  in  modern  civilization.  But  as  civili- 
zation advances  we  begin  to  see  more  clearly  that  its 
dangers  lie  in  the  one-sidedness  which  it  impresses 
upon  our  lives  —  the  tendency  to  specialize  in 
grooves.  Our  intellects  are  not  overtaxed  as 
wholes,  but  in  parts.  The  blacksmith's  arm  may 
yield  to"  hammer  palsy  "from  overuse;  the  scribe's 
fingers  lose  their  cunning  in  the  same  way  through 
writer's  cramp.  Business  life  has  a  very  strong 
tendency  to  limit  our  mental  growth  to  one  line; 
and  in  science  we  are  already  beginning  to  say  with 


Education  99 

real  grief,  as  one  after  another  of  the  leaders  passes, 
"  There  goes  the  last  of  our  all-round  naturalists," 
or  "  physicists,"  or  "  our  great  family  doctors." 

Assuming,  then,  that  our  child  has  been  made  to 
see  color  and  form  understandingly,  to  know  and 
enjoy  it;  his  fingers  made  dexterous  with  all  man- 
ner of  tools,  and  his  heels  with  skates ;  that  numbers, 
symbols,  triangles,  words  and  their  values,  the  form 
of  the  world,  its  parts  and  products,  and  the  do- 
ings and  wisdom  of  them  that  dwell  therein  are 
being  unfolded  before  him,  let  us  have  in  mind  at 
every  step  that  it  is  not  the  knowing  of  these,  but 
the  appreciation  of  their  relations  to  each  other, 
that  constitutes  the  well-educated  person.  The 
faculty  of  associating  knowledge,  comparing,  weigh- 
ing relative  values,  inferring  general  truth  from  de- 
tails, is  the  highest  intellectual  power.  All  others 
are  only  contributors  to  it.  It  links  every  part  of  the 
mind  to  every  other,  strengthening  each  by  each. 
f  Sanity  has  been  defined  in  a  previous  chapter  as 
harmony  with  one's  psychic  environment,  j  This  ex- 
presses the  fact  from  a  social  point  of  view.  The 
individual,  viewed  by  himself,  may  be  similarly  de- 
fined as  being  sane  in  proportion  as  his  own  little 
inner  world  of  wishes  and  ideas  is  in  harmony  with 
itself.  The  education  which  unifies  the  mind,  pro- 
motes mutual  comprehension  between  different 
regions  of  thought,  prevents  clashing  of  views,  puts  \ 
notions  in  their  right  place,  and  sets  the  will  in  its  V 
place  at  the  head,  is  that  which  builds  for  sanity  of 
mind. 


ioo  Sanity  of  Mind 

For  the  sake  of  clearness,  the  following  points 
will  be  considered  in  order:  Activity,  Observation, 
Memory,  Attention  (and  self-control),  Logic,  and 
Judgment. 

i.  Activity  is  the  key  to  all  mental  growth  of  a 
well-balanced  and  healthy  sort.  The  type  of  intel- 
lectual character  which  is  to  be  built  up  is  the 
active,  the  original,  the  self-controlled.  It  is  fitting 
to  place  activity  at  the  beginning,  because  it  isj 
the  characteristic  of  normal  infancy  and  childhood., 
The  child's  nature  craves  to  be  doing  something, 
making  something;  it  is  this  profoundly  basic  ten- 
dency that  makes  "card-pricking,"  carpentering,  and 
gymnastics  the  favorite  occupations  in  summer  free 
schools.  We  all  learn  by  doing ;  children  begin  by 
making  this  rule  universal. 

It  is  worth  hours,  nay  years,  of  reflection,  for  the 
teacher  to  get  an  insight  into  the  principle  that  ac- 
tion is  on  a  higher  plane  than  thought.  Not  mechani- 
cal, unconscious  reflex,  or  unconsidered  action,  but 
action  based  on  correlative  thought,  is  what  is 
meant.  Neither  is  muscular  activity  and  skill  what 
is  meant,  though  the  bodily  accomplishments  are  of 
the  highest  importance.  The  principle  to  be  recog- 
nized is,  that  every  one  of  our  feelings  and  thoughts 
has  its  correlated  outward  expression,  and  that  the 
laws  of  physiology,  of  mental  health,  and  of  char- 
acter, require  the  completion  of  thought  or  feeling 
by  expression  in  action.  And  as  that  which  com- 
pletes is  the  higher,  so  action  is  higher  than  feeling 
or  thought. 


Education  101 

We  have  no  need  to  undervalue  the  intellectual 
pleasures,  nor  the  desires  and  feelings.  A  desire  or 
sentiment  is  fuel  to  the  mental  engine.  Yet,  the 
object  of  an  engine's  existence  is  not  merely  to  get 
up  steam,  but  to  make  the  steam  work.  In  this 
there  is  involved  the  antithesis  of  sentiment  and 
sentimentality,  which  has  never  been  better  ex- 
pressed than  in  the  words  which  I  quote  from 
Phillips  Brooks: 

The  great  human  sentiments  are  the  only  universal  and 
perpetual  powers  .  .  .  It  is  not  sentiment,  but 
sentimentality,  which  is  weak  and  rotten.  Sentiment  is 
live,  and  terse,  and  solid;  sentimentality  is  dead,  and 
flaccid,  and  corrupt.  Sentiment  is  just;  sentimentality 
has  the  very  soul  of  injustice.  Sentiment  is  kind; 
sentimentality  is  cruel.  Sentiment  is  intelligent;  senti- 
mentality is  senseless.  Sentiment  is  fed  straight  out  of 
the  heart  of  truth;  sentimentality  is  distorted  with  per- 
sonal whims  and  preferences.  Sentiment  is  active;  sen- 
timentality is  lazy.  Sentiment  is  self-sacrificing;  senti- 
mentality is  self-indulgent.  Sentiment  loves  facts; 
sentimentality  hates  them.  Sentiment  is  quick  of  sight; 
sentimentality  is  blind.  In  a  word,  sentiment  is  the 
health  of  human  nature  and  sentimentality  is  its  disease. 

In  spite  of  th^  strong  practical  bent  of  our  race, 
there  is  an  immense  amount  of  emotionalism  preva- 
lent. We  have  made  gains  since  the  time  when  girls 
envied  each  other  the  power  of  fainting;  they  now 
prefer  to  be  good  at  "  putting."  The  temptations 
of  to-day  lie  in  a  different  direction.  ^Esthetic  en- 
joyments are  placed  before  us  in  such  profusion  that 


102  Sanity  of  Mind 

it  is  hard  not  to  run  into  a  debilitating  excess  under 
the  guise  of  "  culture."  It  is  confessedly  the  object 
of  art  to  affect  the  feelings — but  there  is  a  choice 
between  ways  of  expressing  them.  As  a  rule, 
the  natural  reflex  act  of  shedding  tears  is  not  the 
thing  to  be  aimed  at  in  raising  emotion  to  a  higher 
plane.  It  is  good  in  itself,  because  natural,  but  it 
does  not  go  far  enough.  A  better  vent  for  the  feel- 
ing of  moral  elevation  which  art  produces  would  be 
\  the  writing  of  a  neglected  letter,  the  mending  of  a 
/neglected  rent,  the  payment  of  the  music-teacher's 
I  long-neglected  bill — in  a  word,  taking  some  trouble 
/  /  to  lift  a  moral  burden. 

Probably  the  most  insidious  form  of  mental 
voluptuousness  is  the  hearing  of  brilliant  sermons 
and  lectures.  In  fact,  all  mental  enjoyment  which 
remains  in  the  purely  passive  state  tends  to  the 
weakening  rather  than  the  strengthening  of  the 
mind.  Instances  of  the  desired  active  attitude  of 
mind  include  the  simple  recalling  of  what  was  said ; 
the  analysis  of  an  argument ;  a  discussion,  and  an 
attempt  to  make  another  person  feel  it  as  the  hearer 
did.  Teachers  make  use  of  this  principle  in  asking 
the  scholars  to  repeat  or  write  out  a  story  which  has 
been  read  to  them.  Mothers  who  read  to  their 
children  have  a  great  opportunity  of  eliciting  native 
thought  by  these  means. 

The  overcoming  of  inertia,  mental  or  bodily,  is 
something  to  which  children  must  be  trained  till  it 
becomes  habitual.  Ready  responses,  prompt  obe- 
dience, alacrity  in  undertaking,  are  wholesome 


Education  103 

habits.  The  whole  tendency  of  the  education 
should  be  to  discourage  saying"  I  can't."  Shrink- 
ing from  pain,  from  effort,  from  the  disagreeable  in 
our  daily  contacts,  is  a  sort  of  moral  cowardice ;  to 
learn  to  do  the  disagreeable  without  hesitation  is 
one  of  life's  best  lessons.  '  When  you  are  ashamed 
to  do  anything,  go  straight  and  do  it." 

In  a  word,  character  is  the  power  to  say  Yes  and 
No,  and  this  power  is  of  immense  importance  for 
mental  health.  Childhood  is  the  time  for  this. 
From  one  fourth  to  one  third  of  the  cases  of  hysteria 
originate  before  the  age  of  fifteen.  Hysteria  is  of 
all  nervous  disorders  perhaps  the  nearest  allied  to 
insanity ;  and  it  is  certainly  the  one  condition  which 
is  most  amenable  to  the  control  of  the  will.  The 
hysterical  child  too  readily  obeys  eccentric  and  mor- 
bid suggestions;  it  needs  to  establish  a  closer  con- 
nection between  its  lower  and  emotional  states  and 
the  higher  powers  of  will  and  judgment.  As  J.  H. 
Lloyd  observes ' : 

A  defective  or  unwise  education  has  much  to  do  with 
the  production  of  hysteria.  The  child  that  is  constantly 
indulged,  never  corrected  or  controlled,  taught  to  regard 
itself  and  its  own  wishes  as  always  first,  allowed  to  excite 
the  emotions  and  imagination  with  fictitious  literature, 
not  disciplined  to  self-control,  to  self-denial,  to  duty, 
and  to  the  cultivation  of  the  higher  moral  and  intellectual 
faculties,  is  the  child  that  is  most  apt  to  display  the 
symptoms  of  hysteria.  It  must  not  be  inferred,  how- 
ever, that  hysteria  is  necessarily  perverseness,  selfishness, 

1  American  Text-Book  of  Diseases  of  Children,  1894,  p.  729. 


104  Sanity  of  Mind 

and  simulation.  This  is  a  too  common  error,  and  one 
which  unjustly  attaches  to  hysteria  a  certain  measure  of 
opprobrium  and  contempt.  It  is  true,  rather,  that  in 
some  of  the  finest  minds  a  defective  education  leaves  un- 
developed the  essential  qualities  of  self-knowledge  and 
self-control. 

2.  Observation  is  so  manifestly  the  business  of 
childhood  that  I  need  only  mention  its  claims. 
The  unobservant  type  of  child  is  apt  to  be  the  in- 
active. It  will  of  course  be  understood  that  self- 
observation  is  not  what  I  mean ;  the  introspective 
type  is  naturally  the  unobservant. 

The  following  quotation  from  R.Brudenell  Carter1 
seems  to  me  to  touch  upon  a  matter  of  the  greatest 
importance,  and  I  heartily  concur  with  his  con- 
clusion : 

The  matters  which  are  lost  by  the  short-sighted,  as  by 
the  partially  deaf,  make  up  a  very  large  proportion  of 
the  pleasures  of  existence.  I  am  accustomed,  on  this 
ground,  strongly  to  urge  upon  parents  the  necessity  of 
correcting  myopia  in  their  children;  and  I  am  sure  that 
a  visual  horizon  limited  to  ten  or  even  twenty  inches, 
with  no  distinct  perception  of  objects  at  a  greater  dis- 
tance, has  a  marked  tendency  to  produce  habits  of  intro- 
spection and  reverie  and  of  inattention  to  outward  things, 
which  may  lay  the  foundation  of  grave  defects  of  char- 
acter. 

Among  a  variety  of  useful  suggestions  about  chil- 
dren, Warner 9  has  some  on  the  introspective  habit, 

1  Loe.  cit.,  pp.  105,  106. 

*  Growth  and  Means  of  Training  the  Mental  Faculty,  p.  94. 


Education  105 

or  the  habit  of  probing  one's  own  character.  He 
justly  says  that  when  this  necessary  operation  is 
undertaken,  it  should  be  with  the  full  energy  of  the 
waking  mind.  He  finds  that  children  may  fall  into 
the  way  of  doing  this  after  going  to  bed,  and  allow- 
ing the  train  of  thought  to  exhaust  their  brains,  in- 
stead of  falling  at  once  to  sleep.  For  such  tendencies, 
he  recommends  muscular  exercise ;  or,  where  needed, 
rest  by  lying  down  in  the  daytime ;  or  the  stimulus 
of  outward  ideas,  supplied  by  having  a  story  read 
aloud,  or  some  pleasant  imagery  suggested  to  the 
imagination. 

3.  Memory,  as  denoting  the  name  of  a  faculty,  is 
a  kind  of  generalized  expression  for  the  power  of> 
storing  and  reproducing  impressions,  which  belongs 
not  to  the  brain  alone,  but  to  nervous  tissue  in  gen- 
eral. It  furnishes  a  sensitive  index  of  the  condition 
of  the  nervous  system,  for  the  time  being,  whether  of 
vigor  or  depression.  Its  loss  is  a  usual  indication 
of  the  approach  of  age.  Remarkable  memories  are 
not  in  themselves  a  proof  of  superior  general  mental 
power;  they  occur  in  some  cases  associated  with 
semi-idiocy,  though  they  are  also  the  gift  of  many 
of  the  ablest  of  men.  It  is  often  said  that  the 
power  of  memory  depends  on  the  attention  and  con- 
centration of  mind  that  is  employed  when  an  object 
is  present.  This  is  so  far  true  that  very  little 
mental  work  of  any  kind  can  be  done  without  con- 
centration, j  But  no  degree  of  effort  in  attention  will 
make  up  for  lack  of  vigor  of  perceptive  power. 

The  value  of  memory  depends  very  much  on  its 


io6  Sanity  of  Mind 

quality.  Haziness,  uncertainty,  or  vagueness  of 
thought  characterize  intoxication,  idiocy,  enfeeble- 
ment  of  mind-power  in  general.  The  opposite 
states  of  clearness  and  definiteness  are  tokens  of 
vigor.  We  recognize  the  fact  in  our  daily  experi- 
ences, when  we  find  that  a  fresh  mind  clears  up 
problems  and  brings  things  back  to  memory  which 
were  our  despair  when  in  a  state  of  weariness. 

A  young  child's  instinct  has  leadings  towards  the 
establishing  of  habits  of  definiteness.  In  pictures, 
that  which  is  preferred  is  the  single  object — a  horse, 
a  man,  by  itself.  Repetition  pleases ;  the  old  story 
or  the  old  rhyme  can  be  given  scores  of  times — and 
it  must  be  given  in  its  original  form,  each  incident 
as  it  was  first  told,  or  objection  is  made. 

It  is  to  be  feared  that  the  habit  of  clear  memory 
is  impaired  by  some  parts  of  the  school  work  of 
many  children.  /  A  teacher  who  is  satisfied  with  un- 
clear ideas  for  her  own  mental  housekeeping  is  not 
likely  to  help  children  in  this  matter.  Many  a 
young  person  has  a  good  native  faculty  of  memory, 
but  displays  a  confused  memory  of  his  studies.  In 
Latin,  for  example,  he  may  make  a  fair  translation, 
and  yet  may  be  hazy  in  his  mind  about  almost  every 
detail  of  the  lesson :  the  meaning  of  the  English 
equivalent  used,  the  pronunciation,  the  tense,  etc., 
of  the  verbs  that  occur,  are  points  upon  which  he 
feels  no  certainty,  and  frequently,  also,  there  is  no 
rational  meaning  attached  to  the  passage.  The 
school  years  pass  on,  only  increasing  the  general 
fogginess  of  the  subject — years  of  positive  injury  to 


Education  107 

the  thinking  powers,  apart  from  the  gross  waste  of 
time. 

"  This  boy  has  never  learned  how  to  study,"  is  a 
common  complaint.  Children  are  not  made  to 
know  what  they  are  about  and  how  to  go  about  it ; 
what  the  object  of  a  lesson  is,  and  how  to  attack  it, 
and  how  to  know  whether  they  have  succeeded. 

4.  It  is  of  more  importance  to  a  child  to  have  the 
power  of  application,  that  is,  of  attending  to  the  sub- 
ject, than  to  know  every  fact  that  is  taught  in  the 
school.  To  hold  the  children  strictly  to  their  tasks, 
and  yet  to  recognize  the  limits  of  their  power  of 
attention,  is  a  work  of  the  highest  skill  in  teaching. 

Application  (attention)  is  not  only  the  basis  of  all 
learning,  but  it  is  in  itself  a  form  of  moral  discipline, 
being  a  direct  act  of  the  will  in  obedience  to  a  sense 
of  responsibility.  This  view  gains  in  importance 
when  we  recall  the  facts  that  are  reported  as  to  the 
mental  state  of  the  average  young  criminal.  Pre- 
cisely the  inability  to  apply  the  will  to  continuous 
mental  effort  is  what  is  there  noticed.  Of  the 
fifteen  hundred  young  men  in  Elmira  Reformatory, 
sixty  per  cent,  are  illiterate,  cannot  read  and  write 
at  all,  or  only  with  difficulty.  The  inability  to  at- 
tend is  perfectly  characteristic  of  their  mental  state 
when  they  begin  their  studies  in  the  institution. 
They  practically  labor  under  a  deficiency  in  will- 
power as  regards  this  form  of  effort.  There  is 
plenty  of  stubbornness,  but  not  much  power  to 
adhere  to  a  new  and  unfamiliar  purpose.  School 
work,  mostly  elementary,  is  one  of  the  essentials  in 


io8  Sanity  of  Mind 

establishing  new  habits  in  the  boy  to  be  reformed ; 
the  application  and  perseverance  required  are  actual 
curative  agencies. 

The  unsteadiness  of  attention  here  described  is 
traceable  back  in  many  cases  to  the  sensational  life 
of  city  streets  from  which  a  large  number  of  young 
criminals  spring  up. 

The  continual  distraction  of  the  city  streets  is  bad  for 
the  child  intellectually;  in  keeping  him  from  continued 
earnest  application  to  a  single  end,  it  prevents  the  forma- 
tion of  an  individuality.  The  whole  tendency  of  these 
street  confusions  is  toward  both  an  unstable  nervous 
system  and  an  unstable  character.1 

Hence  truancy  and  illiteracy ;  and  from  the  truant 
of  ten  to  fifteen  years  there  springs  the  young 
"  tough,"  and,  later,  the  "  first  offender"  on  his 
way  to  a  reformatory. 

A  defective  control  over  the  temper  is  typical  of 
a  large  class  of  criminals.  The  favored  means  of 
imparting  this  control  at  Elmira  is  by  training  in 
the  use  of  tools,  by  the  method  known  as  sloyd. 
In  the  very  beginnings,  in  the  simplest  possible 
processes  of  measuring  and  cutting,  the  beginner  is 
apt  to  show  impatience,  bad  temper,  or  what  we  call 

nervousness  "  when  we  ourselves  display  it.  The 
wood  in  which  one  works  then  becomes  a  record,  an 
unimpeachable  witness  of  the  failure  to  attend  or 
to  control  oneself.  Thus  the  mind  is  trained  step 

1  Report  on  Vacation  Schools  and  Playgrounds, — Borough  of 
Manhattan  and  the  Bronx,  1898. 


Education  109 

by  step  in  the  habit  of  putting  itself  to  a  task  and 
holding  itself  there.  The  pupil  is  shown  by  ex- 
perience that  success  in  the  making  of  any  article 
depends  on  the  moral  qualities  of  attention,  pa- 
tience, self-control  which  are  put  into  the  work. 
Irresponsibility  and  want  of  self-respect  are  thus  in 
the  end  replaced  by  a  sense  of  conscious  power  over 
matter  —  and  over  self. 

Manual  training  is  only  one  of  the  best  among 
many  methods  of  developing  self-control.  The 
moral  benefit  is  obtainable  from  anything  which  re- 
quires perseverance.  To  the  reforming  felon,  it  is 
of  the  greatest  practical  importance  to  learn  ele- 
mentary arithmetic  and  writing,  and  the  struggle  he 
makes  in  forcing  himself  to  conquer  them  is  worth 
even  more  to  his  character  than  the  knowledge 
gained. 

Attention,  self-control,  and  obedience  to  law  are 
three  trunks  which  spring  from  one  root.  It  is  more 
than  mere  coincidence  when  the  teacher  says,  "  I 
must  have  order  before  I  can  teach."  I  am  strongly 
inclined  to  think  that  the  basis  of  the  power  which 
the  kindergarten  displays  in  civilizing  children  is 
largely  centred  in  its  wise  development  of  the  power 
of  attention,  giving  to  it  a  continuity  and  a  unity 
which  is  altogether  lacking  in  the  "  training  of  the 
street."  That  this  power  is  beginning  to  be  ac- 
knowledged by  those  who  understand  the  masses,  is 
seen  in  reports  from  various  localities,  of  which  the 
following  l  may  serve  as  a  type : 

^Report  of  Chicago  Schools,  1898. 


1 10  Sanity  of  Mind 

The  transformation  in  the  actions,  language,  and 
spirit  of  the  young  children  who  are  taken  from  the 
street  and  placed  in  the  kindergarten  is  wonderful.  At 
first  many  are  combative,  resentful,  rude,  selfish,  greedy, 
and  show  the  perverting,  degrading,  demoralizing  influ- 
ences common  to  the  undisciplined  child.  A  few  months' 
training  in  a  good  kindergarten  makes  these  same  chil- 
dren neat,  obedient,  self-helpful,  thoughtful,  and  help- 
ful to  others  ;  disciplines  them  unconsciously  to  right 
thought  and  action,  and  lays  the  foundation  for  the 
development  of  true  men  and  women. 

Among  the  list  of  virtues  which  that  most  practi- 
cal of  men,  Benjamin  Franklin,  drew  up  that  he 
might  exercise  himself  therein,  there  stands  one  not 
commonly  recognized  under  the  name  he  gave  it — 
"  Tranquillity."  His  intimacy  with  the  Quakers  of 
his  adopted  town  is  more  likely  to  have  suggested 
this  than  his  Boston  life.  While  writing  this  chap- 
ter, I  came  upon  a  quaint  illustration,  which  reminds 
one  of  the  practices  of  that  sect.  In  one  of  our 
largest  and  best  institutions  for  the  feeble-minded, 
I  was  shown  into  a  room  where  a  dozen  of  the  least 
intelligent  were  sitting  side  by  side.  '  What  are 
these  girls  supposed  to  be  doing  ?  "  was  my  question. 

They  are  sitting  still ;  they  are  doing  it  as  a  part  of  the 
day's  programme,  just  as  they  will  presently  dress  for  a 
walk  out-of-doors.  To  sit  still  for  a  certain  time  is  a 
part  of  the  daily  plan  for  all  the  children,  and  it  is  found 
to  have  a  most  beneficial  influence  in  lessening  that  ex- 
citability and  noisy  rudeness  which  are  so  common  among 
neglected  children  when  admitted  here. 


Education  1 1 1 

Surely  there  is  something  in  this  which  is  based 
on  the  soundest  psychology.  Violent  acts  and 
words  wake  a  loud  echo  in  the  mind ;  but  enforced 
quiet  of  body,  the  "  relaxation  "  of  Miss  Call,  is  a 
calmative  agent  in  nervous  states. 

And  this  deliberate  calming  of  impulse  is  har- 
monized in  the  same  institution  with  most  vigorous 
incitement  of  the  dull  mind  by  appeals  with  voice, 
movement,  color,  form,  models,  pictures,  sports, — 
everything  to  wake  up  the  intellect.  /  It  is  a  serious 
mistake  to  confound  quiet  with  stupidity. 

No  one  who  reads  the  literature  of  insanity  can 
fail  to  notice  that  self-control  is  insisted  upon  as  of 
great  importance  as  a  means  of  checking  tendencies 
to  mental  disorder.  Perhaps  some  light  is  thrown 
upon  the  connection  of  these  two  by  what  we  have 
been  considering.  Rather  than  myself  take  the  ex- 
horter's  stand,  let  me  call  to  my  aid  a  sentence  from 
the  author  of  Sartor  Resartus  V 

In  which  habituation  to  obedience,  truly,  it  was  be- 
yond measure  safer  to  err  by  excess  than  by  defect. 
Obedience  is  our  universal  duty  and  destiny;  wherein 
whoso  will  not  bend  must  break.  Too  early  and  too 
thoroughly  we  cannot  be  trained  to  know  that  Would, 
in  this  world  of  ours,  is  as  mere  zero  to  Should,  and  for 
most  part  as  the  smallest  of  fractions  even  to  Shall. 


The  habitual  disobedience  of  young  people  to  the 
rightful  authority,  whether  that  of  a  parent,  or  of 
a  conductor,  captain  of  a  vessel,  driver,  or  others 

1  Loc.  cit.,  ii.,  2. 


ii2  Sanity  of  Mind 

placed  in  charge  of  our  lives,  has  so  forcibly  struck 
Dr.  Stearns  that  in  his  excellent  work  on  Prevention 
of  Insanity  he  speaks  of  it  as  a  national  trait,  and  as 
a  mental  habit  which  may  well  be  mentioned  among 
things  which  predispose  to  mental  derangement. 

In  the  kindred  field  of  reform  we  have  many  other 
attestations,  from  among  which  I  select  the  follow- 
ing, expressing  the  conviction  of  one  of  the  wisest 
and  strongest  friends  of  criminal  women  —  the  late 
Mrs.  Ellen  C.  Johnson,  head  of  the  Massachusetts 
Reformatory  Prison  for  Women : 

I  am  convinced  that  to  inefficient  parental  manage- 
ment may  be  attributed  a  large  proportion  of  the  crimes 
that  fill  our  prisons,  because  it  leaves  the  child  without 
the  foundation  of  obedience  and  self-control,  upon  which 
alone  may  be  built  the  superstructure  of  enduring  man- 
hood and  womanhood.  Time  and  again  have  I  heard 
from  the  lips  of  sentenced  prisoners  the  pathetic  confes- 
sion of  a  wayward  and  disobedient  childhood,  of  passions 
indulged,  of  speech  unbridled,  of  habits  formed  by  the 
pressure  of  untoward  circumstances,  without  efficient 
check  or  guidance  from  those  whose  first  obligation  was 
the  proper  training  of  the  soul  entrusted  to  their  keeping. 

5.  I  will  not  discuss  the  value  of  the  training  im- 
parted by  mathematics  and  logic.  What  may  be 
said  under  this  head  has  already  been  partly  indi- 
cated in  remarks  upon  the  need  of  accuracy,  under 
Memory. 

Good  judgment  should  be  sharply  distinguished 
from  logic.  The  logician  may  be  compared  to  a 


Education  113 

bridge-builder;  he  can  construct  by  the  laws  of  his 
profession  —  which  is  a  grand  thing, —  but  unless  he 
has  judgment  about  materials,  the  work  will  not 
stand.  Skill  in  the  dialectic  art  is  a  snare  to  its 
possessor,  if  not  balanced  by  skill  in  judging  of 
premises. 

Good  general  judgment  means  a  knowledge  of  the 
values  of  things.  Values  are  relative  and  mutual. 
The  value  of  one  thing  is  its  power  in  relation  to 
another, — its  influence  upon  the  other.  We  learn 
values,  therefore,  by  associating  our  knowledges. 
Here  the  doctrine  of  "  apperception  "  comes  use- 
fully into  play.  For  an  illustration  of  my  meaning, 
take  the  case  of  an  architect  who  is  planning  to 
decorate  a  schoolroom,  and  thinks  of  colored  ceilings 
and  walls.  Each  color  suggests  three  ideas  to  him : 
his  own  enjoyment  of  it  ;  its  supposed  cheering  in- 
fluence ;  its  harmony  with  other  decorations.  He 
selects  red.  A  chance  memory  occurs  to  his  mind — 
"  Red  is  trying  to  the  eyes," — and  his  judgment  is 
reconstructed  on  the  wider  basis  of  four  ideas. 

The  habit  of  seeing  into  things  ought  to  be  en- 
couraged from  the  beginning,  as  far  as  sorts  with 
the  child's  age.  The  thoughtless  child  is  he  who 
does  not  connect  his  act  with  other  persons'  lives. 
The  "  want  of  imagination,"  so  called,  which  is 
really  only  the  habit  of  not  joining  other  interests 
to  our  own,  makes  one  selfish  and  harsh.  Selfish- 
ness is  often  a  negative  trait — a  want  of  good  moral 
manners  —  a  product  of  the  parents'  neglect  and 
want  of  social  insight ;  a  manifestation  not  so  much 


ii4  Sanity  of  Mind 

of  evil  character  as  of  want  of  trained  sense.  Sensi- 
bleness  is  a  pretty  valuable  endowment,  and  high  in 
the  mental  scale,  too,  for  if  this  analysis  be  correct 
it  springs  from  a  free  use  of  that  power  in  the  brain, 
of  late  development,  whereby  one  region  of  the 
cellular  substance  communicates  with  another. 

The  mental  training  that  brings  about  this  condi- 
tion must  be  interwoven  with  the  child's  develop- 
ment; it  cannot  begin  too  soon  (though  it  may 
easily  be  overdone),  but  it  must  take  an  increasingly 
prominent  position  as  the  faculties  enlarge.  The 
forming  of  associations  between  arithmetic  and 
geography,  language  and  history,  geography  and 
history;  the  habit  of  seeing  through  the  imagina- 
tion ;  the  converting  of  book-lore  into  realities ;  the 
refusal  to  rest  in  empty  words,  and  the  insistence 
upon  getting  at  "  the  bottom  facts  "  of  any  subject 
—  these  instances  may  help  in  some  degree  to  con- 
vey my  meaning.  The  enemy  of  all  this  is  what  is 
called  "  cram."  Great  public  systems  of  examina- 
tion are  based  upon  cram.  Whole  sets  of  school 
and  professional  books  are  written  to  meet  the  de- 
mand for  cramming  —  you  will  find  those  that  con- 
sist of  nothing  but  sets  of  detached  questions  from 
end  to  end.  There  is  no  doubt  of  the  loss  of  mental 
power  which  such  practices  bring.  It  is  possible, 
by  adherence  to  strict  memory  methods,  to  ruin  the 
powers  of  the  growing  student  for  thoughtful  study. 

"  Considerateness  "  is  a  term  for  the  habit  which 
some  minds  have,  of  letting  any  new  notion  come 
readily  under  the  controlling  influence  of  many 


Education  115 

others,  whereby  a  balance  is  established,  self-control 
asserts  itself,  and  momentary  jets  of  feeling  are  kept 
from  undue  influence  over  our  acts.  The  trait  is 
not  characteristic  of  young  children  and  requires 
cultivation. 

The  train  of  thought  which  was  begun  as  an  analy- 
sis of  mental  disciplines,  has  led  us,  again  and  again, 
by  inevitable  associations  into  the  domain  of  what  is 
called  morals.  It  would  have  fallen  short  of  its 
practical  uses  if  it  had  not  done  so ;  for  sanity  and 
morality  cannot  be  separated.  A  very  frequent 
manifestation  in  insanity  is  its  dissociative  action. 
It  throws  one  out  of  sympathy  with  neighbors  in 
many  ways;  it  disqualifies  the  patient  from  civic 
and  legal  functions.  The  egoism  of  the  insane 
is  perhaps  not  a  universal,  but  it  is  a  vast  fact. 
Where  it  is  not  self-assertive  it  is  at  least  self- 
centred,  and  burrows  in  its  own  viscera,  self-para- 
sitic, self-poisoned. 

The  following  quotation  '  vividly  depicts  the  ego- 
istic, neurotic  type  of  young  persons,  associated  with 
unfortunate  parental  influences : 

There  is  one  case  in  which  this  [parental]  influence  is 
directly  productive  of  insanity,  and  that  is  the  case  of 
an  hysterical  girl  with  a  foolish,  weak,  indulgent,  fussy, 
anxious  mother.  The  mothers  of  hysterical  girls  are 
often  of  this  description,  and  their  influence  upon  their 
children  is  noxious  in  a  high  degree.  The  girl  whose 
salvation  depends  on  being  "taken  out  of  herself"; 

1  Mercier,  Sanity  and  Insanity,  p.  372. 


n6  Sanity  of  Mind 

upon  having  her  attention  withdrawn  from  her  own 
ccensesthesia  (general  sensations),  and  concentrated  upon 
externals;  upon  being  induced  and  compelled  to  interest 
herself,  not  in  her  own  feelings,  but  in  what  is  going  on 
in  the  world  around  her;  is  taken  in  hand  by  an  over- 
solicitous  mother;  put  to  bed;  shut  off  as  far  as  possible 
from  commerce  with  varied  scenes  and  external  interests; 
and  taught  by  continual  inquiry  into  "  how  she  feels," 
by  continual  expatiation  to  friends  and  visitors  upon  her 
delicacy  and  precarious  condition,  to  concentrate  and 
intensify  the  interest  that  she  is  naturally  predisposed  to 
take  in  her  own  sensations;  and  is  thus  urged  and  wor- 
ried into  a  condition  which  always  partakes  of  the  nature 
of  insanity,  and  which  occasionally  culminates  in  a  def- 
inite outbreak  of  mania. 

The  single  point  of  imitation  of  the  parent's  traits 
is  of  so  great  importance  in  forming  a  child's  char- 
acter as,  in  the  minds  of  many,  quite  to  put  in  the 
shade  the  influences  of  heredity.  The  neurotic 
child  must  be  placed  with  women  who  have  a  calm, 
healthy,  cheerful  temper,  a  steady  will,  affectionate 
feelings,  and  common  sense;  to  which  may  fairly  be 
added  the  requirement  that  they  should  be  trained 
in  a  good  school  of  care-taking,  one  of  the  best  of 
which  is  doubtless  a  well-conducted  kindergarten. 

The  following  summary  statement  from  the  pen 
of  one  long  known  as  a  student  of  this  subject1  will 
furnish  an  appropriate  conclusion  of  this  discussion. 

'Mary  Putnam  Jacobi,  "The  Prevention  of  Insanity,  and  the 
Early  and  Proper  Treatment  of  the  Insane,"  Journal  of  Social 
Science,  No.  xv.,  1882. 


Education  1 1 7 

The  three  great  elements  in  the  moral  substratum  of  a 
person  predisposed  to  insanity  are:  the  egotistical  pre- 
dominance of  the  instincts  over  the  faculties  of  reflection 
and  external  relation;  the  ineffectiveness  of  the  will, 
even  when  this  is  impulsive  or  violent;  the  inaptitude  for 
ideas,  resulting  in  their  poverty  and  imperfect  combina- 
tion. The  whole  nature  is  shrunken  upon  itself;  there 
is  not  enough  vital  turgesence  to  expand  it  to  its  normal 
circumference,  and  to  the  point  of  contact  of  this  with 
the  external  world.  The  cardinal  point  in  the  manage- 
ment of  such  natures  is,  therefore,  the  expansion  of  their 
shrunken  individuality.  This  is  to  be  effected  by  means 
of  a  strenuous  educational  system,  directed  at  once  tow- 
ards the  repression  of  the  egotistic  instincts,  the  enrich- 
ment and  systematization  of  the  ideas,  and,  through 
multiplication  of  acts  and  external  relations,  the  energiz- 
ing of  the  feeble  will.  .  .  .  There  is  needed  a  far- 
sighted,  comprehensive,  minute  education  which  should 
begin  with  the  dawn  of  consciousness,  and  extend,  if 
possible,  through  life. 


CHAPTER  V 

SELF-EDUCATION 
Sapiens  ;  sibi  qui  imperiosus. — HORACE,  Sat.,  ii.,  7. 

THE  age  of  twenty-one  confers  upon  the  growing 
young  man  the  privileges  of  an  adult,  as  re- 
spects his  social  relations.  He  is  conventionally 
"  grown  up  "  at  that  age.  Measurements  of  stature, 
however,  indicate  continued  growth,  in  many  cases 
extending  to  the  twenty-fifth  year.  There  are  some 
data  which  point  to  a  further  growth  up  to  the  age 
of  thirty,  but  this  remains  a  mooted  point  with 
anthropologists. 

Measured  by  character,  we  find  a  different  scale 
of  things.  Examination  of  photographs  at  fourteen 
and  twenty-one  shows  great  changes,  but  the  com- 
parison of  twenty-one  with  forty  is  equally  striking 
in  point  of  development  of  intelligence. 

Man's  life  is  of  such  a  nature  that  it  never  rests 
long  in  one  attitude.  Our  growth  is  a  succession  of 
growths,  each  with  its  trajectory  curve,  rising  rapidly 
and  then  declining  more  slowly,  t  In  each  case,  it  is 
first  mass,  then  function.  Bones  grow  big  before 
their  final  cause,  the  muscles,  do  so ;  muscle  is  bulky 
before  it  is  skilful;  brain  is  full-sized  long  before  it 

118 


Self-Education  119 

understands  itself.  It  is  matter  of  plausible  con- 
jecture, that  a  well-used  brain  grows  in  size  up  to 
middle  life ;  but  it  seems  to  me  that  mere  bulk  is  of 
small  consequence  compared  with  the  increase  in 
functional  aptitude  which  we  acquire  in  the  school 
of  the  world ;  and  which  in  declining  years  it  is  our 
duty  so  far  as  possible  to  defend  from  shrinkage  and 
waste.  Considering  this  later  growth  in  a  moral 
sense,  we  find  that  the  responsibility  for  it  is  placed 
upon  our  own  shoulders.  We  pass  from  youth  with 
the  degree  of  A.  H.,  or  adultus  homo,  which  entitles 
us  to  practise  in  any  court  of  the  world,  without 
further  initiation  fee;  but  our  pranks,  henceforth, 
are  no  longer  to  be  considered  as  student-follies;  we 
are  our  own  president  and  faculty,  and  self-govern- 
ment becomes  a  solemn  fact. 

A  pretty  large  percentage  of  those  who  read  a 
chapter  of  this  sort  are  more  or  less  personally  inter- 
ested in  the  question  of  the  tendencies  towards  in- 
sanity, and  the  means  of  neutralizing  them.  We 
care  for  our  children  and  our  relatives ;  so  far  as  we 
can  see  our  own  case,  we  care  for  ourselves.  In  this 
chapter  I  wish  to  speak  of  that  small  class  who  are 
concerned  about  their  own  mental  state ;  and  of  that 
larger  class  who  ought  to  be  so  concerned. 

As  originally  conceived,  the  plan  of  this  little  book 
laid  stress  upon  the  idea  of  Self-Control.  A  smaller 
book,  by  a  Mr.  Barlow,  called  Man's  Power  over 
Himself  to  Prevent  or  Control  Insanity,  had  pre- 
sented this  idea  in  a  forcible  way,  and  it  seemed 
worthy  of  expansion  in  a  new  form.  Maturer 


120  Sanity  of  Mind 

reflection  enlarged  the  plan,  of  which  this  chapter 
represents  the  first  phase. 

In  pursuing  the  idea  of  self-control  we  have  as- 
suredly a  very  valuable  clew.  I  do  not  merely  mean 
that  we  are  in  harmony  with  the  Scriptures  and  with 
the  wiser  men  of  antiquity,  but  that  there  is  a  genu- 
ine connection  between  sanity  and  self-control. 

A  popular  French  comedy  represents  the  worthy 
but  excitable  ptre  de  famille  at  a  moment  when 
something  has  "  contraried  "  him  seriously.  His 
wife  and  female  relatives  exhort  him  to  calm  him- 
self, but  he  vigorously  replies:  "  I  won't  be  quiet! 
I  want  to  be  angry  —  just  as  angry  as  I  can  hold !  " 
Where  is  the  use  of  being  endowed  with  passions  if 
we  don't  get  pleasure  out  of  them?  The  ideal  of 
the  savage  is  similar — "  What  is  the  use  of  drinking 
unless  I  get  drunk  ?  " 

The  effects  of  anger  have  been  picturesquely  de- 
scribed by  sages  and  poets,  with  whose  writing  my 
readers  are  familiar.  One  of  the  most  curious 
studies  in  this  direction  is  Stanley  Hall's  thesis,1 
based  on  questions  submitted  by  correspondence  to 
a  large  number  of  persons.  It  is  interesting  to  note 
among  these  the  frequent  expressions  of  regret,  and 
the  references  to  great  pain  and  mental  suffering, 
and  even  bodily  exhaustion,  which  are  associated 
with  fits  of  rage  in  the  personal  experience  of  the 
writers. 

Anger  is  perhaps  the  best  type  of  a  thing  to  be 

1  G.  Stanley  Hall,  "A  Study  of  Anger,"  Amer.  your.  Psychology, 
vol.  x.,  No.  4. 


Self-Education  1 2 1 

controlled.  It  is  a  great  gift — a  man  is  incomplete 
without  the  power  of  indignation ;  we  all  agree  that 
there  must  be  something  wrong  in  a  person  who  is 
not  angry  in  certain  cases,  but  is  it  not  worth  while 
to  have  the  power  to  control  it,  if  only  with  regard 
to  our  own  interests  ? 

Outside  of  the  great  passion  of  healthy,  justifi- 
able, controllable  anger,  there  is  a  wide  field  of 
affections  which  are  morbid,  in  that  they  go  far  be- 
yond the  justification.  Many  of  us  go  about  full 
of  bottled  wrath  and  fretfulness,  like  a  big  spider 
full  of  venom  with  which  we  sting  those  who  get  in 
our  way.  If  we  needed  them  for  our  food,  as  the 
spider  does  flies,  we  might  have  a  justification.  But 
we  do  not  need.  The  better  way  would  be  to  hire 
some  one  to  "  paddle  "  us  efficiently,  and  so  draw 
out  the  irritation  through  the  skin ;  or  to  take  a 
walk  or  a  run  or  to  visit  the  gymnasium.  Perhaps  a 
cup  less  of  coffee,  or  less  meat  or  eggs,  or  less  of  the 
heady  beverages  that  are  drawn  from  wood  and 
bottles,  or  a  more  judicious  supper,  may  cut  off  the 
tap-root  of  the  bastard  weed,  nervous  irritability. 
Or  perhaps  tobacco  ?  How  we  slide  into  the  nar- 
cotic habit,  unconscious  what  is  hurting  us  until  it 
costs  a  revolution  to  undo  the  harm !  It  is  like  our 
municipal  affairs;  people  do  not  care  much  about 
abuses  until  they  are  grown  unendurable,  and  then 
there  is  a  universal  upheaval  and  a  casting  out  of 
offenders.  Gout  is  becoming  more  common  in 
America  than  it  used  to  be ;  one's  temper  is  apt  to 
be  bad  in  gout,  or,  if  you  please,  in  other  morbid 


122  Sanity  of  Mind 

concoctions  of  the  humors,  and  here  is  a  good 
chance  to  regulate  temper  by  diet.  Sedentary 
habits,  want  of  fresh  air,  muscular  indolence,  with 
many  people  determine  ill-temper  as  one  determines 
sleep  by  morphine.  Do  we  know  one  or  two  nice 
things  that  upset  us  ?  and  is  it  not  human  nature  to 
go  on  trying  them  again  and  again  in  the  false 
optimism  of  self-indulgence  ? 

What  petty  things  these  all  are,  and  yet  how  they 
ruin  half  the  pleasure  of  life  !  So  be  it;  some  of 
them  are  petty ;  but  not  so  with  gout,  for  instance, 
which  is  a  red  flag  showing  where  a  side  track 
switches  off  towards  insanity.  Not  so  with  the  irri- 
tability of  overworked  nerves,  which  warns  of  nerv- 
ous prostration ;  or  the  irritability  of  tea  and  coffee, 
which  may  either  be  an  index  of  nervous  instability 
already  acquired,  or  may  help  on  towards  the 
acquisition. 

There  is  no  doubt  in  anyone's  mind  of  the  per- 
nicious effect  of  starving  the  body;  it  starves  the 
nerves,  resistant  and  stubborn  though  they  are  to 
the  effects  of  starving ;  it  lays  a  foundation  for  al- 
most any  kind  of  nervous  disease — neuralgia,  morbid 
pains  in  queer  spots,  sleeplessness,  mental  irritabil- 
ity, and  breakdown.  Now,  people  differ  greatly  in 
their  powers  of  eating.  Some  must  have  an  interval 
of  ten  hours  between  meals;  most  are  best  with 
four  or  five  hours;  but  not  a  few  are  benefited  by 
putting  in  a  slight  repast  between  meals, — I  do  not 
mean  the  spoiled  child's  appetite  which  wants  candy 
before  dinner.  Starvation  of  the  nerves  is  also  com- 


Self-Education  123 

monly  effected  by  lunches  of  toast  with  strong  tea, 
or  tea  alone.  Neither  tea,  coffee,  spirituous  wines, 
nor  the  ordinary  extract  of  beef  are  a  proper  foun-  \ 
dation  for  a  noon  meal ;  they  are  all  delusive,  all 
substitute  stimulus  for  nutrition,  and  lead  to  nervous 
ruin. 

I  believe  there  is  a  lurking  feeling  in  favor  of  pas- 
sion in  the  minds  of  highly  moral  people.  They 
express  it  when  they  remark,  "What  a  relief  it  is  to 
swear  a  little,  sometimes!  "  The  position  thus  held 
is  unscientific.  It  is  now  understood  that  grimaces 
and  gestures  expressive  of  violent  feeling  tend  to 
increase  the  feeling  by  a  sort  of  reflex  action  ;  which 
fact  lies  at  the  basis  of  what  is  called  "  working 
oneself  into  a  passion."  A  calm  posture  calms  the 
mind. 

It  is  not,  in  fine,  irrelevant  to  call  attention  to  the 
fact  that  the  classes  of  human  beings  who  are  typi- 
cally subject  to  explosions  of  anger  are  the  epileptic 
and  the  feeble-minded.  By  the  side  of  these  we 
may  range  the  victims  of  poison,  as  seen  in  alcoholic 
frenzy  and  the  temporary  insanity  of  the  hashish 
eater. 

That  a  fit  of  rage  may  be  the  "  psychic  equiva- 
lent "  of  an  attack  of  epilepsy  (with  convulsions  left 
out)  is  a  rather  startling  doctrine,  when  we  apply 
it  to  ourselves. 

The  doctrine  of  equivalence  can  be  also  used  to 
show  us  the  safe  way  out  of  an  attack :  for  as  we 
give  to  excitable  insane  patients  work  to  do  with  the 
hands,  so  we  may  treat  our  own  honored  selves  to  a 


124  Sanity  of  Mind 

turn  at  the  carpenter's  bench,  or,  lacking  that,  may 
supply  the  muscular  equivalent  with  gymnastics. 

The  main  object  of  this  chapter,  however,  is  to 
point  out  the  mental  rather  than  the  physical  agen- 
cies for  strengthening  the  mind  to  resist  the  inva- 
sion of  insanity.  Now,  if  we  entertain  doubts  as  to 
the  facts,  we  are  merely  wasting  time  in  discussing 
these  agencies.  If  we  are  living  under  the  fatalistic 
impression  which  is  so  easily  brought  on  by  hearing 
of  one  or  two  strong  cases  of  heredity,  or  by  partial 
reading  of  cases,  the  whole  argument  in  regard  to 
self-control  will  take  a  goody-goody  aspect,  and  will 
seem  a  perfunctory  preachment  on  the  author's 
part.  I  must  therefore  ask  the  reader  to  make  it 
clear  to  his  own  mind  whether  he  has  any  doubt 
whatever  that  character  is  built  up;  whether  or 
no  he  has  a  share  in  the  building  ;  whether  he 
has  the  power  of  choosing  between  different  ways 
of  spending  his  time;  whether  he  has  even  a 
fractional  power  over  himself  in  fixing  or  in 
diverting  his  thoughts.  The  argument  rests  on 
considerations  like  these,  which  the  reader  may  ap- 
ply for  himself. 

One  who  lives  with  the  insane  comes  to  recognize 
that  they  are  often  perfectly  responsible  for  their 
good  or  bad  behavior;  perfectly  aware,  too,  that 
their  peculiar  status  protects  them  from  punish- 
ment. They  may  deliberately  take  advantage  of 
this  impunity  to  perpetrate  horrid  crimes.  On  the 
other  hand,  we  see  that  on  certain  occasions  they 
are  far  more  able  to  control  themselves  than  one 


Self-Education  125 

I 

would  suppose;  at  chapel  services,  theatricals,  lec- 
tures, dances,  they  put  themselves  on  their  good 
behavior  and  observe  the  proprieties  remarkably 
well.  Are  not  the  sane  also  amenable  to  motives 
for  self-guidance  in  a  far  higher  degree  ? 
/  The  pith  of  the  matter  seems  to  lie  in  this,  that 
mind  and  body  each  act  on  the  other.  If  physi- 
cal fatigue  may  depress  the  spirits,  a  motive  for 
hope  or  good  cheer  will  take  away  fatigue.  Fear 
of  cholera  kills  hosts;  a  stubborn  will  to  live  has 
kept  death  from  many  a  sick  man.  Courage,  hope,  , 
cheerfulness,  turning  the  thoughts  outward,  activity 
in  the  unselfish  directions,  and  a  clear  head  withal, 
combine  to  affect  the  vital  processes  favorably :  cir- 
culation, respiration,  digestion,  are  improved  under 
their  influence,  and  fatigue  and  pain  are  banished.1 
The  fatalistic  view  creeps  in  again  under  the  guise 
of,  "  Happiness  is  after  all  a  matter  of  temperament 
—  we  are  born  happy  or  the  opposite."  If  that 
view  is  cheering  and  helpful,  cling  to  it !  But  do 
not  deliberately  adopt  it  that  you  may  have  an  ex- 
cuse for  remaining  unhappy. 

1  Dr.  Wilson  has  some  very  interesting  remarks  on  the  mental 
physician's  point  of  view,  as  he  conceives  it.  "  By  all  means,"  he 
says,  "let  us  exhaust  the  full  resources  of  the  physical  method,  but 
at  the  same  time  let  us  avail  ourselves  of  the  spiritual.  After  all, 
the  spiritual  relation  of  brain  cells  is  as  big  a  thing  and  as  important 
as  their  chemistry.  Iron  and  strychnine,  phosphorus  and  Indian 
hemp,  are  very  potent  remedies ;  but  so  also  are  fear,  doubt,  hope, 
confidence,  interest,  enthusiasm.  Moral  causes  overturn  many  a 
mind  and  brain,  and  moral  causes  may  restore  them." — Clinical 
Studies  in  Vice  and  in  Insanity,  by  George  R.  Wilson,  M.D.,  1899, 
p.  126. 


i26  Sanity  of  Mind 

The  reader  will  pardon  the  assumption  of  a  horta- 
tory tone.  The  practical  application  now  follows. 

Social  relations,  companionship,  friendship,  are 
of  the  greatest  value,  and  are  a  good  deal  under  our 
own  control.  We  can  have  too  much  of  them ;  but 
with  the  average  man  society  is  as  necessary  for  the 
mind  as  oxygen  for  the  body.  It  is  not  merely  a 
question  of  mental  quickness  —  it  may  be  a  matter 
of  sanity  or  its  loss. 

In  the  wide  wastes  of  plain,  bearing  no  vegetation 
but  the  sage-bush  and  grass,  the  life  of  a  cattle- 
herder  upon  a  range  is  intensely  lonely  and  monot- 
onous. I  have  been  made  acquainted  with  such  a 
case,  in  which  several  of  the  men  became  succes- 
sively insane  under  these  influences.  The  owner  has 
succeeded  in  applying  a  remedy.  She  (it  happens 
to  be  a  lady)  makes  appeal  to  her  friends  in  the 
cities  for  the  gift  of  old  magazines  and  novels  and 
other  light  reading  for  the  use  of  the  cattlemen, 
and  finds  that  the  remedy  meets  the  case. 

Dr.  H.  P.  Stearns :  has  forcibly  presented  the 
isolated  life  of  some  farmers'  wives  as  follows : 

The  currents  of  thought  and  care  have  gone  on  day 
after  day,  and  month  after  month,  from  early  morning 
until  late  at  night  in  one  ceaseless  round;  wakeful  and 
anxious  often  for  children  sick,  for  children  who  are  to 
be  clothed  and  fed  and  schooled;  anxious  in  reference 
to  the  thousand  and  one  household  cares  which  never 
lift  from  the  brain  of  such  a  mother;  with  no  intellectual 

1  Insanity  :  Its  Causes  and  Prevention,  p.  204. 


Self-Education  127 

or  social  world  outside  the  dark  walls  and  many  times 
illy  ventilated  rooms  of  her  own  house;  with  no  range 
of  thought  on  outside  matters ;  with  no  one  to  interpose 
or  even  understand  the  danger;  with  no  books  to  read, 
or,  if  she  had,  no  time  to  read  them; — in  short,  with  no 
vision  for  time  or  eternity  beyond  one  unending  contest 
with  cooking,  and  scrubbing,  and  mending, — what  won- 1 
der  that  the  poor  brain  succumbs!  The  wonder  rather 
is  that  it  continues  in  working  order  so  long  as  it  does 
without  becoming  utterly  wrecked.  More  fresh,  health- 
giving  air,  more  change,  more  holidays,  more  reading, 
more  gossiping,  more  of  almost  anything  to  change  the 
monotony  of  such  a  life,  to  break  the  spell  which  so 
holds  these  poor  women,  and  to  lead  their  minds  in 
pastures  more  green,  and  by  rivers  whose  waters  are  less 
stagnant  and  bitter  ! 

A  cloistered  life  not  only  tends  to  narrow  one's 
round  of  ideas  and  judgments,  but  it  gives  an  open 
field  for  the  operations  of  a  class  of  agencies  which 
specialists  recognize  as  leading  towards  insanity  — 
insistent  ideas,  haunting  thoughts,  impulses  which 
keep  dogging  one's  steps.  The  feeling  that  one  has 
committed  a  social  blunder,  or  that  some  one  else 
has  snubbed  us,  or  that  we  have  just  lost  some  great 
opportunity,  or  have  done  an  injustice,  or  caused 
pain,  or  in  a  hundred  possible  ways  have  transgressed 
the  line  of  social  or  religious  obligation,  — this  feel- 
ing, common  to  all  of  us,  is,  with  some,  based  on  an 
element  of  character  which  actually  threatens  sanity. 
It  is  quite  possible  to  nurse  such  feelings  for  the 
sense  of  excitement  they  give,  for  the  same  reason  ' 


128  Sanity  of  Mind 

that  one  may  like  the  sensation  of  anger.  There  is 
a  gratification  in  self-reproach,  for  it  seems  like  a 
kind  of  retribution.  There  are  also  those  who,  after 
the  loss  of  a  friend  by  death,  cherish  and  try  to  per- 
petuate the  first  feelings  of  anguish,  and  reproach 
themselves  when  time  lays  a  healing  hand  upon  the 
wound.  When  possessed  by  these  morbid  cravings 
for  suffering,  these  self-torturings  acquiesced  in  by 
a  stagnant  will,  the  remedy  is  outside  of  ourselves ; 
our  best  friend  may  be  the  merest  stranger  whom 
we  accost  in  the  market  and  who  obliges  us  to  think 
for  a  moment  in  a  new  direction.  We  cannot  sup- 
press such  trains  of  feeling  directly,  by  a  fiat  of  will, 
but  we  can  divert  them.  (,  The  next  best  thing  to  a 
friend  is  an  occupation;  and  in  the  long  run  an 
occupation  fills  very  much  the  larger  space  in  our 
lives.  / 

Self-absorption,  or  downright  selfishness,  is  a  fre- 
quent trait  in  insanity.  We  excuse  it  in  the  insane, 
but  in  ourselves  we  have  no  right  to  it.  Living 
much  in  ourselves  is  immoral;  self-examination  is 
alternately  self-flattery  and  self-pity,  and  its  whole 
tendency  is  towards  an  unbalanced  state  of  the 
faculties. 

Much  of  this  morbid  habit  has  been  fostered  by 
the  romantic  utterances  of  the  poets  and  sages,  of 
which  we  find  a  plenty  in  the  eighteenth  century. 
A  contemplative  mind  like  Wordsworth's  may  find 
it  wholesome  to  spend  much  time  in  vigorous  lonely 
walks  amid  grand  and  fascinating  scenery;  a  Tho- 
reau  may  be  at  his  best  in  a  wild  wood ;  and  how 


Self-Education  129 

many  a  tired  citizen  is  but  too  thankful  to  camp  out 
where  there  is  nobody  but  a  guide  to  speak  to! 
But  the  morbid  or  affected  character  of  much  of  the 
nature-worship  of  the  romantic  school  of  Chateau- 
briand's day  is  now  happily  seen  in  its  true  light. 
There  is  a  tinge  of  this  quality,  I  suspect,  even  in 
so  sensible  a  work  as  Feuchtersleben's  Dietetics  of 
the  Soul,  where  we  read:  "  Let  men  say  what  they 
will  in  praise  of  society.  The  most  they  can  say  of 
it  is  that  it  teaches  us  to  know  our  duty ;  but  from 
solitude  alone  can  we  derive  happiness."  ' 

And  as  for  diaries,  there  are  two  sorts :  the  objec- 
tive, which  chronicles  oneself  only  as  one  among 
many  other  incidents,  and  makes  material  for  future 
history ;  and  the  subjective,  which  is  practically  the 
liturgy  of  self-worship,  the  consequence  and  the 
cause  of  tendencies  to  inward  deterioration. 

"  A  hypochondriac  whom  I  attended,"  says  Feu- 
chtersleben,  "  became  convalescent  from  the  mo- 
ment that  I  prohibited  him  from  continuing  a  journal 
which  he  kept  of  his  condition."  * 

A  correct  insight  into  one's  own  character  is 
necessary.  But  the  habit  of  self-analysis,  self-intro- 
spection, self-punishment,  is  not  the  way  to  reach 
this  knowledge.  The  evolution  of  our  character  is 
a  matter  of  contact  and  comparison  with  others, 
taking  the  best  as  our  standard ;  the  more  of  out- 
ward experience  and  contacts  we  have,  on  a  fair 
footing  of  give-and-take,  the  wiser  our  judgment 

1  Translation  published  by  C.  S.  Francis  &  Co.,  1854,  p.  144. 
*  Principles  of  Medical  Psychology,  Sydenham  Society,  1847. 
9 


130  Sanity  of  Mind 

unconsciously  becomes  in  regard  to  our  own  con- 
dition. 

Although  there  is  a  danger  in  the  enthronement  of 
deductive  logic,  yet  there  are  cases  in  which  a  gen- 
eral principle  has  been  well  made  out,  from  which 
inferences  of  great  value  can  be  drawn.  A  few  of 
these  may  be  briefly  discussed  here. 

One  important  general  principle,  bearing  directly 
on  the  genesis  of  mental  disease,  relates  to  the  ne- 
cessity of  providing  suitable  outlets  for  the  existing 
energies  of  mind  and  body.  Taken  by  itself,  the 
principle  would  involve  letting  people  gratify  every 
propensity,  irrespective  of  morality.  There  is  cer- 
tainly a  mental  stress  involved  in  resistance  to  pro- 
pensity ;  and  if  the  avoidance  of  stress  were  the  only 
consideration  in  life,  propensity  would  carry  the  day 
in  more  ways  than  it  now  does.  But  I  must  leave 
morality  to  defend  itself;  our  concern  is  now  with 
other  considerations.  I  propose  to  notice  the  men- 
tal damage  which  may  be  wrought  by  neglect  to 
employ  faculty ;  using,  first,  a  notable  historical  case. 

The  mental  affliction  through  which  John  Bun- 
yan  passed,  between  the  ages  of  twenty  and  twenty- 
four,  is  instructive  in  more  ways  than  one,  if 
we  accept  the  able  analysis 1  of  Professor  Royce. 
This  wonderful  and  untaught  genius  was  of  an  ir- 
ritable, nervous  constitution,  which  in  childhood 
showed  itself  by  terrible  dreams  in  which  devils  and 
wicked  spirits  were  prominent  actors.  His  educa- 
tion was  extremely  meagre.  As  a  young  man,  his 

1  Studies  of  Good  and  Evil. 


Self-Education  131 

social  gifts  and  his  aesthetic  tastes  displayed  them- 
selves in  a  passionate  attachment  to  dancing  and 
chime-ringing.  His  native  power  of  language, 
queerly  enough,  found  vent  in  an  extraordinary 
copiousness  of  profane  expressions.  He  had  also 
the  habit  of  amusing  himself  on  Sunday  with  out- 
door sports.  Soon  after  his  marriage  he  gave  up  the 
two  latter  indulgences,  and  subsequently  wrenched 
himself  away  from  dancing  and  even  from  bell- 
ringing.  {  He  was  now  without  amusements;  he  was 
without  an  outlet  for  his  most  characteristic  powers 
and  tastes.  Shut  in  to  himself,  with  much  reading 
of  the  Bible,  he  became  a  victim  to  "  temptations," 
or,  as  we  should  express  it,  to  the  insistent  idea  of 
his  own  utter  depravity  —  his  chief  "  sins"  being 
those  I  have  mentioned.  Suggestions,  in  the  form 
of  blasphemous  solicitations,  distressed  him  to  the 
verge  of  endurance.  At  last  all  his  temptations 
were  concentrated  upon  the  one  idea,  which  "  in- 
termixed itself  in  almost  whatever  he  thought  "  that 
he  must  "  sell  Christ  ";  to  which  at  last,  in  utter 
weariness,  he  yielded. 

This  yielding  plunged  him  in  a  fixed  and  deep 
melancholy.  It  did,  however,  set  him  entirely  free 
from  the  racking  anguish  of  "  temptation," — the 
strain  of  perpetual  mental  antagonism  to  himself, — 
and  may  thus  be  said  to  have  been  the  first  step 
towards  his  recovery.  Bunyan  thus  furnishes  us  an 
illustration  of  a  second  leading  principle  in  mind- 
healing,  namely,  the  value  of  submission  to  the 
inevitable.  Perhaps  we  may  compare  this  with  the 


i32  Sanity  of  Mind 

influence  of  "  power  through  repose,"  which  has 
recently  been  praised  for  its  good  effects  upon  neu- 
rotic temperaments.1 

At  all  events,  upon  Bunyan's  restoration  to  health 
he  joined  in  fellowship  with  a  Christian  church  and 
assumed  a  set  of  duties  which  taxed  all  his  powers 
until  his  death  at  the  age  of  sixty.  Constant 
preaching,  and  much  writing,  to  the  extent  of  sixty 
works,  great  and  small,  were  the  regimen  which 
preserved  him  from  relapse  into  his  malady  for  the 
rest  of  his  life.  One  need  not  seek  for  better  testi- 
mony of  the  virtue  of  occupation  as  a  mental  tonic ;  \ 
or,  in  other  words,  of  the  necessity  for  an  outlet  for 
one's  gifts. 

/No  feature  of  modern  asylum  treatment  has 
proved  of  greater  value  than  the  introduction  of 
occupation  for  the  insane.  Work  at  the  mechanic 
trades,  at  housekeeping,  waiting,  cooking,  sewing, 
and  all  sorts  of  out-door  labor  on  farms  and  roads, 
has  proved  an  immense  blessing.  As  for  the  the- 
ory of  the  way  in  which  good  is  done,  no  one  with 
an  understanding  of  the  needs  of  average  human 
nature  will  require  to  be  told  of  the  comfort  and 
strength  that  lie  in  regular  habits,  and  the  misery 
of  ennui.  For  the  inmates  of  hospitals,  we  may 
add  to  this  the  benefit  of  physical  health  accruing 
from  the  exercise. 

Mr.  Wyckoff,  in  his  recent  book,  The  Workman, 
gives  a  vivid  account  of  the  intolerable  mental  dis- 
comfort suffered  by  some  lumbermen  among  whom 

1  See  the  book  with  this  title  by  Annie  Payson  Call. 


Self-Education  133 

he  was  thrown  on  the  occasion  of  an  undesired  holi- 
day. They  happened  to  be  illiterate  men,  with  no 
mental  resources  for  off-days  except  the  animal 
pleasures  of  a  debauch  in  the  settlement.  An  in- 
structive contrast  is  offered  in  his  own  intense 
longing  for  contact  with  books,  after  a  protracted 
voluntary  absence  from  his  home  associations,  while 
experimenting  in  the  practical  earning  of  his  living 
by  the  labor  of  his  hands. 

Dr.  Mercier '  has  some  pointed  remarks  on  retir- 
ing from  business,  which  will  bear  quoting : 

There  is  one  other  circumstance,  connected  with  the 
means  of  livelihood,  that  is  apt  to  produce  stress  in  those 
who  are  subjected  to  its  influence;  and  that  is  the  sud- 
den cessation  of  work  by  one  who  has  been  for  many 
years  accustomed  to  a  uniform  course  of  toil.  The  dis- 
appointment that  is  in  store  for  those  who  have  been 
looking  forward,  during  a  lifetime  of  toil,  to  the  period 
of  golden  leisure  that  they  shall  enjoy  in  the  evening  of 
their  days,  has  become  a  stock  subject  for  the  moralist 
for  many  generations.  All  have  heard  of  the  soap-boiler 
mentioned  by  Dr.  Johnson,  who,  after  selling  his  busi- 
ness, begged  of  his  successor  to  allow  him  to  come  up  on 
melting  days  and  witness  the  operation ;  and  the  anecdote 
illustrates  a  state  of  things  which  is  extremely  com- 
mon. A  man  who  has  all  his  life  been  in  active  employ- 
ment, who  has  not  only  always  had  abundant  outlet  for 
all  his  activities,  but  who  has,  by  long  habit,  so  modified, 
and  moulded,  and  trained  his  nervous  system  that  a 
certain  amount  of  activity  is  forthcoming  every  day,  sud- 
denly relinquishes  his  employment,  and  stops  up  the 
1  Sanity  and  Insanity,  pp.  270,  271. 


134  Sanity  of  Mind 

channels  by  which  these  habitually  accumulating  energies 
were  habitually  expended.  What  must  happen  is  clear. 
The  activities  will  not  suddenly  cease.  The  man  may 
voluntarily  relinquish  the  habitual  modes  of  employing 
himself,  but  he  cannot,  at  a  few  days'  notice,  so  modify 
his  nervous  system  as  to  cause  it  to  abandon  habits 
which  have  been  the  growth  of  a  lifetime.  The  activi- 
ties still  continue  to  be  felt.  \  The  energies  still  continue 
to  be  generated;  but,  cut  off  from  their  normal  and 
habitual  mode  of  expression,  they  accumulate;  they  be- 
come pent  up;  and,  unless  outlet  is  found  for  them,  they 
will  infallibly  produce  disorderA  Hence  we  find  that 
when  a  man  in  the  evening  of  life,  or  about  the  time  that 
was  considered  by  the  ancients  his  grand  climacteric,  re- 
tires from  his  business,  he  is  subject  to  stress;  and  if  by 
this  time  his  energies  have  not  much  diminished,  but 
are  still  very  active;  and  if  he  has  no  alternative  occupa- 
tions in  which  he  can  find  outlet  for  his  unemployed  activ- 
ities, this  stress  is  extremely  likely  to  produce  disorder. 
Within  six  months  I  have  been  consulted  about  five 
gentlemen,  all  of  whom  were  becoming,  or  were,  insane, 
from  this  cause.  All  of  them  were  men  of  great  bodily 
and  mental  activity,  all  about  the  same  age,  all  had  re- 
cently retired  from  active  business,  and  —  here  is  the 
significant  fact — all  of  them  were  destitute  of  mental  re- 
sources. Not  one  of  them  ever  opened  a  book;  not  one 
of  them  had  a  hobby;  not  one  of  them  cared  for  music 
or  any  form  of  recreation,  with  the  sole  exception  of  one 
who  occasionally  played  golf,  and  one  who  occasionally 
played  chess.  Not  one  of  them  took  any  active  part  in 
social,  municipal,  or  political  life.  It  is  remarkable  that 
the  cases  of  insanity  arising  from  this  cause  usually  ex- 
hibit the  same  symptoms.  In  all  the  above  five  cases 


Self-Education  135 

the  patients  were  very  wealthy  men,  and  each  one,  upon 
relinquishing  his  business,  sank  into  melancholia,  and 
cherished  the  belief  that  he  was  miserably  poor. 

No  one  who  stifles  a  legitimate  impulse  of  feeling 
can  be  secure  from  the  revenge  it  may  hereafter 
take.  /  The  social  proprieties;  mistaken  views  of 
duty;  the  unconscious  tyranny  of  the  stern  man 
over  the  cheerful ;  the  false  modesty  which  touches 
elbows  with  a  neighbor  for  a  year  without  speaking; 
the  harsher  forms  of  religious  belief,  with  much 
else  that  might  be  mentioned,  in  life  as  we  know  it 
to-day,  cause  enormous  waste  of  possible  happiness, 
and  therefore  of  health.  Christianity  at  its  outset 
burst  asunder  all  these  mummy  wraps,  and  gave 
to  the  world  the  spectacle  of  a  community  which 
fully  gratified  in  its  members  the  grande passion  of 
brotherly  love  —  a  greater  power,  perhaps,  than  the 
sexual  passion  which  is  commonly  so  called.  A 
recent  sect,  with  enthusiastic  views  of  the  matter  of 
healing  the  sick,  owes  much  of  its  rapid  success  (I 
have  heard  it  suggested)  to  the  warmth  of  kindly 
and  equal  brotherhood  which  welcomes  the  new- 
comer to  their  fold,  and  which  fills  the  aching  void 
in  hearts  that  cannot  be  satisfied  with  material 
grandeur  and  a  business  life. 

"  Falling  into  a  rut  "  is  the  besetting  temptation 
of  more  advanced  age.  It  is  easier  on  the  whole  to 
do  as  we  have  previously  done.  There  comes  a 
time  in  life  when  the  impulse  for  change  and  nov- 
elty grows  weaker,  and  the  surplus  energy  less;  it 


136  Sanity  of  Mind 


is  then  that  we  need  an  external  or  a  novel  stimulus. 
This  is  the  period  when  the  tendency  to  dementia, 
or  the  wasting  away  of  mental  power,  comes  in; 
and  there  is  no  doubt  that  this  evil  tendency  is 
favored  by  the  growing  fixity  and  settledness  of 
middle  life  —  das  gesetzte  Alter, — with  the  prepon- 
derance of  material  interests  and  the  reluctance  to 
keep  up  with  innovations,  which  belong  to  this  age. 
This  kind  of  settledness  adds  to  one's  comfort,  in  a 
way,  but  the  indulgence  in  this  comfort  acts  upon 
the  intellect  with  a  slowly  numbing  influence.  I  am 
not  recommending  that  a  man  should  change  his 
business  or  his  residence  in  middle  life ;  but  he  is  to 
be  envied  who  can  change,  at  the  hour  of  closing 
business  for  the  day,  to  some  real  interest  of  an- 
other sort,  which  has  the  power  of  attracting  and 
pleasing.  Many  of  us  cannot  like  whist,  but  for 
those  who  do  it  is  often  a  capital  stimulant,  and,  at 
the  worst,  is  better  than  dozing. 

Occasional  depression  of  spirits  is  a  very  common 
thing,  even  in  sound  and  well-balanced  minds.  It 
is  very  important  to  draw  the  line  between  this  oc- 
currence and  the  form  of  insanity  called  melancholia. 
In  the  vast  majority  of  cases,  occasional  depression 
has  nothing  to  do  with  insanity  or  insane  tendency. 

Still,  low  spirits  depress  not  only  our  feelings,  but 
our  powers.  They  egotistically  turn  the  mind  in 
upon  itself;  they  interfere  with  duties  and  engage- 
ments, and  prevent  application  to  business.  They 
probably  weaken  the  sum  total  of  the  vital  forces  in 
away  not  perceptible  during  the  life  of  the  subject, 


Self-Education  137 

but  possibly  acting  as  a  factor  of  commencing  de- 
terioration in  a  following  generation.  The  possibil- 
ity of  avoiding  the  attacks  by  a  more  judicious  life 
ought  to  be  insisted  upon.  There  are  causes,  physi- 
cal and  moral,  of  many  kinds,  which  it  is  one's 
business  to  seek  for,  not  resting  until  the  whole 
round  of  habits  and  actions  have  been  put  to  the 
test :  one's  up-rising  and  down-sitting,  one's  eating 
and  drinking,  going  abroad,  company,  exercise, 
dress, —  nothing  is  trifling  that  has  a  great  effect. 

I  wish,  however,  to  make  it  plain  that  there  is  no 
justification  in  supposing  that  a  person  who  is  sub- 
ject to  fits  of  the  blues  is  entering  a  path  which  leads 
to  melancholia.  As  far  as  can  be  stated,  low  spirits 
act  on  the  nervous  system  in  a  general  way,  as  ex- 
cesses and  irregularities  of  life  do,  and  the  distant 
consequences  are  of  the  greatest  variety  of  char- 
acter. The  mental  training  of  a  low-spirited  and 
fearful  temper  should  therefore  be  directed  to  the 
strengthening  of  the  will  and  courage,  to  the  bear- 
ing of  responsibility,  to  self-control  and  the  facing 
of  duty.  The  cultivation  of  cheerfulness  per  se,  of 
cheerfulness  at  all  hazards,  is  not  the  summing  up 
of  the  case ;  there  are  moods  of  sternness,  there  are 
hours  of  pain  and  stress,  which  also  make  for  the 
soul's  health. 

Neurasthenia,  nervous  prostration  or  breakdown, 
is  marked  by  low  spirits,  with  decided  lessening  of 
mental  endurance.  The  mental  suffering  may  be 
great,  but  there  is  no  derangement ;  it  is  not  an  in- 
sanity. Whether  extreme  and  protracted  cases 


i38  Sanity  of  Mind 

may  shade  off  into  insanity,  and  actually  develop 
into  it  in  normally  minded  persons,  is  a  matter  upon 
which  there  is  some  difference  of  opinion.  An  in- 
herited predisposition  to  insanity  would  make  the 
transition  comparatively  easy.  But  in  point  of  fact 
a  simple  neurasthenia  very  rarely  develops  into  insan- 
ity. It  may  distinctly  influence  the  following  gen- 
eration, however,  as  a  moderate  predisposition. 

It  is  in  nervous  troubles  of  this  sort,  with  little 
visible  bodily  cause,  that  we  see  most  brilliantly  dis- 
played the  power  of  mental  influence  in  bringing 
about  a  cure.  I  regard  them  as  almost  certainly 
curable,  in  part  or  in  whole,  by  such  methods. 

A  patient's  fatalism  in  these  matters  is  too  often 
backed  up  by  the  physician's  materialism,  both  com- 
bining to  negative  the  influence  of  encouragement. 
Medical  scepticism,  aroused  by  the  preposterous 
combinations,  the  "  shot-gun  doses,"  of  the  old 
time,  has  insisted  on  simplification,  and  on  methods 
which  at  least  enable  us  to  judge  what  drug  has 
helped  the  patient.  But  in  doing  this  it  has  con- 
scientiously put  out  of  court  the  "  disturbing  ele- 
ment "  of  mental  anticipation,  and  has  made  a 
practice  of  letting  the  drug  do  its  work  unaided. 
The  attitude  of  the  profession,  it  must  be  confessed, 
is  at  this  day  one  of  indifference  to  mental  influences. 
They  appear  in  an  unscientific  and  therefore  an 
undignified  light  to  the  man  who  is  taught  strictly 
to  rely  on  the  microscope,  test-tube,  and  other 
instruments  of  precision.  (  The  omission  of  practical 
teaching  in  psychology  from  the  list  of  required 


Self- Education  1 39 

studies  has  been  suggested  as  another  cause  of  this 
attitude.  Through  the  door  thus  left  open  have/ 
come  in  various  humane  and  sympathetic  (however 
ill-balanced)  doctrines  of  mind-healing,  the  results 
of  which,  thoroughly  in  accord  with  what  we  know 
of  mental  physiology,  furnish  most  valuable  con-  \ 
formation  of  the  view  which  is  enforced  in  this 
chapter.  The  power  of  suggestion,  acting  imper-  / 
ceptibly  upon  the  feeling  of  faith  or  confidence  in  a 
sufferer's  mind,  appears  to  be  at  the  basis  of  these 
cures;  and  cures  there  are,  far  too  numerous  to  be 
pooh-pooh'd. 

While  all  classes  of  minds  are  open  to  the  influ- 
ences of  suggestion  and  imitation,  a  much  greater 
openness  is  noticed  in  children  and  in  the  unedu- 
cated. And  these  influences  work  in  both  directions. 
There  are  many  facts  which  point  to  the  prevalence 
of  nervous  disorders  of  psychic  origin  in  the  unedu- 
cated classes  or  the  badly  educated  and  "  spoiled." 
The  experience  of  Dr.  James  J.  Putnam  '  leads  him 
to  include  in  this  class  the  accident  neuroses  —  the 
paralytic  or  nervous  troubles  which  supervene  at  a 
more  or  less  distant  time  after  railroad  or  other  acci- 
dents : 

The  patients  who  suffer  from  the  severe  forms  of  these 
disorders  are,  strangely  enough,  of  the  mechanic  or 
wage-earning  class,  who,  although  sturdy,  and  used  to 
hardship  of  various  sorts,  are  apt  to  be  lacking  in  social 
and  general  experience,  and  are  not  trained  in  the  sort 
of  self-control  that  society  expects  from  its  members, 
1  Shattuck  Lecture,  1899. 


140  Sanity  of  Mind 

while,  at  the  same  time,  their  lack  of  a  fixed  source  of 
income  makes  a  period  of  enforced  idleness  a  matter  of 
great  moment  to  them.  They  are  not,  as  a  rule,  predis- 
posed to  neurotic  inheritance,  and  have  usually  been 
strong  and  healthy,  but  the  traditions  of  the  community 
in  which  they  were  born  and  bred  inculcate  the  instinc- 
tive belief  that  accidents  are  terrible  events  and  lead  to 
mysterious  and  complex  troubles.  To  the  patient  whose 
mind  is  thus  stocked  with  traditions  and  instincts  sym- 
pathetic to  misfortune  there  come  next  the  startling  and 
disabling  circumstances  of  the  accident  itself,  which  de- 
throne the  self-control  and  profoundly  disturb  the  emo- 
tions and  through  them  the  action  of  the  circulation  and 
the  heart;  and  to  this  is  added  the  special  "  suggestion  " 
furnished  by  some  local  injury  or  special  fear.  It  is  then 
as  if  someone  had  whispered  to  the  demoralized  patient, 
"  Your  arm  will  be  paralyzed,"  or  "  You  will  be  an  in- 
valid for  years."  These  cases  are  extremely  numerous, 
and  immense  sums  are  paid  on  them  in  damages. 

A  generalization  of  high  importance  is  involved 
in  the  answer  we  may  give  to  the  question,  "  Whither 
is  the  human  race  tending ;  whither  is  our  own  sec- 
tion of  the  race  tending ;  and  what  have  we  to  hope 
or  fear  from  such  tendency  ? "  In  view  of  what  we 
already  know  of  the  general  rise  of  animal  life,  of 
the  general  uplift  of  intelligence  from  age  to  age  in 
old  geological  time,  and  in  view  also  of  the  rather 
scanty  series  of  facts  relating  to  the  ascent  of  the 
line  of  mammalia  to  which  we  belong,  we  certainly 
have  data  for  estimating  our  own  position  and  pros- 
pects as  a  race.  Man,  the  species,  is  moving  along 


Self-Education  141 

a  certain  line.  He  has  attained  his  present  emi- 
nence by  superior  cerebral  development.  Along 
with  this  ascent,  there  is  an  associated  tendency  in 
the  direction  of  progressive  infirmity  as  regards  cer- 
tain parts  of  our  bodily  frame,  of  which  no  better 
instance  can  be  given  than  the  tendency  to  diminu- 
tion of  the  size  of  the  jaw,  and  lessening  of  the 
number  of  the  teeth  in  man  and  his  progenitors. 
In  fact,  the  view  is  commonly  accepted  among  those 
best  able  to  judge,  that  the  race  of  man,  after  a 
career  of  possibly  some  hundreds  of  thousands  of 
years,  is  now  showing  some  signs  of  having  reached 
or  passed  the  zenith  of  his  anatomical  perfection. 
He  is  now  entering  on  the  stage  of  senescence. 

I  think  we  can  readily  see  the  truth  of  this  claim 
in  some  bodily  details.  We  also  observe  an  appar- 
ent increase,  among  civilized  races,  of  mental  dis- 
ease and  defective  mental  development,  which  can 
fairly  be  claimed  as  related  to  premature  old  age 
in  the  individuals  affected.  Granting,  for  the  sake 
of  the  argument,  that  we  are  forced  to  admit  that 
man  is  in  his  apogee,  can  we  trace  any  connection 
between  the  practices  of  educators  and  this  supposed 
tendency  to  decline  ?  Is  it  likely  that  with  the 
wisest  and  most  enriched  courses  of  training  for 
body,  mind,  and  soul,  we  can  do  anything  to  push 
forward  the  tendency  to  cerebral  improvement; 
and,  if  so,  is  it  wise  for  us  to  court  such  high  for- 
tunes ?  There  is  no  question  that  pedagogy  has 
such  ambitions.  ;  Relying  on  the  physiological 
law  of  human  development  by  periods,  she  has 


142  Sanity  of  Mind 

concluded  that  we  ought  to  ascertain  the  time  of  life 
at  which  each  faculty  is  rapidly  maturing,  and  lib- 
erally to  feed  and  educate  the  growing  powers  at 
such  times,  in  due  subordination  to  considerations 
of  health.  She  tells  us  that  the  training  which 
favors  the  broad  and  all-sided  growth  of  psychic 
faculty  is  the  best,  on  the  whole,  for  the  general 
health  of  the  body,  provided  that  the  individual 
limits  of  power  are  not  overpassed.  She  has  appar- 
ently no  fear  that  her  efforts  to  improve  the  brain 
will  tend  to  hasten  senescence.  Indeed,  I  do  not 
think  it  fair  to  burden  pedagogy  with  such  a  vast 
responsibility.  But  I  certainly  think  the  considera- 
tions advanced  justify  us  in  urging  upon  all  con- 
cerned in  education  the  adoption  of  a  new  criterion 
of  success  in  the  training  of  youth.  I  hold  that  all 
successful  mental  training  is  to  be  judged  as  such 
in  proportion  as  the  recipient  can  be  shown  to  be 
improved  in  his  physical  vigor,  his  constitutional 
strength,  his  power  of  work  and  resistance.  An 
education  which  does  this  justifies  itself:  an  educa- 
tion which  falls  short  of  it  is  open  to  the  suspicion 
of  helping  the  race  in  the  direction  of  degradation. 

Other  things  being  nearly  equal,  it  is  therefore 
seen  that  the  physical  quality  of  the  graduates  of 
school  or  college  is  an  indispensable  test  of  the  ulti- 
mate value  of  the  work  of  such  an  institution. 

The  laws  of  health  are  understood  better  than 
formerly,  and  the  treatment  of  the  insane  has  drawn 
benefit  from  the  improved  knowledge.  With  the 
coming  of  Pinel,  passed  away  the  theory  of  chains 


Self-Education  143 

and  scourging ;  with  the  Friends,  that  of  unnatural 
confinement  and  restraint ;  and  in  our  own  time  we 
are  reaching  out  to  a  wider  extension  of  the  principle 
that  what  is  good  for  the  well  is  good  for  the  in- 
valid. The  lesson  of  a  century  is  that  common 
sense  is  the  wisest  and  the  last  of  lessons  to  be 
learned. 

If  one  wishes  for  rules  to  guide  to  mental  sanity, 
they  may  be  had  in  observing  the  treatment  of  the 
insane  in  the  best  asylums  of  our  day.  But  rules 
are  not  much  wished  for.  The  prevalent  spirit  of 
the  time  is  that  which  is  admirably  expressed  in  the 
quotation  which  follows ' : 

In  place  of  a  health-seeking  instinct  in  America,  we 
have  a  feeling  which  says,  "  I  do  not  mind  how  hard  a 
strain  I  have,  provided  I  can  hold  out  till  I  get  through 
it."  We  are  too  much  employed  to  think  much  of  the 
discomfort  of  moderate  fatigue  and  ill-health.  Neither 
have  we  sufficient  feeling  respecting  the  permanence  of 
the  family  to  lead  us  to  plan  for  a  succession  of  descend- 
ants. An  American  says,  "  I  had  rather  have  forty-five 
or  fifty  years  of  active,  satisfactory  life,  than  sixty  or 
seventy  years  of  a  comfortable,  dawdling  existence"; 
and,  if  we  look  at  the  case  only  as  it  affects  himself,  we 
cannot  especially  condemn  the  reasoning,  but  when  we 
consider  the  constitution  that  this  overstrained  life  be- 
queaths to  the  children,  it  assumes  a  different  aspect. 

In  conclusion  we  may  say  that  no  fixed  set  of 
rules  is  likely  to  be  of  use  in  all  cases  alike,  for  those 

1  Mary  E.  Beedy,  Education  of  American  Girls. 


H4  Sanity  of  Mind 

who  have  reason  to  dread  the  advent  of  insanity, 
either  from  hereditary  tendency,  or  from  neurotic 
constitution.  Those  who  seriously  wish  to  take 
care  of  themselves  ought  above  all  things  to  find 
occupation.'^  If  neurasthenic,  let  them  find  a  wise 
physician  and  be  cured;  and  let  him  explain  to 
them  the  limits  of  their  natural  force,  to  guide  them 
in  their  work.  The  social  must  overpower  the 
selfish  element,  and  the  universe  must  cease  to  re- 
volve around  the  ego.  Dissipation  and  all  unwhole- 
some living  must  yield  to  whatever  contributes  to 
vigor  of  constitution.  And  if  anything  remains  to 
be  said,  let  every  one  consider  how  real,  how  con- 
sistent with  mental  science,  is  the  beneficial  influ- 
ence of  a  hopeful  spirit  and  the  habit  of  looking  on 
the  bright  side.  Religion  and  Science  can  join 
hands  in  praising  the  great  triad,  Faith,  Hope, 
Charity ;  or,  as  Lend  a  Hand  expresses  it,  the  act 
of  "  Looking  up  and  not  down,  looking  forward 
and  not  back,  looking  out  and  not  in." 


CHAPTER  VI 

OUR  SOCIAL  AND  CIVIC  DUTIES 

"  Sir,  wherefore,  since  over  this  place  is  the  way  from  the  City  of 
Destruction  to  yonder  gate,  is  it  that  this  plat  is  not  mended,  that 
poor  travellers  might  go  thither  with  more  security  ?  " 

Pilgrim's  Progress. 

THE  amount  of  actual  insanity  at  the  present 
time  is  of  less  importance  than  the  rate  of 
its  increase.  In  regard  to  neither  do  we  possess 
accurate  information.  The  number  of  the  insane 
reported  by  the  United  States  Census  for  1890  is 
106,485,  which  is  estimated  as  about  one  half  of  the 
probable  actual  number  of  cases.  But  the  increase 
(which  is  the  matter  of  chief  concern)  is  found,  both 
in  Europe  and  America,  to  have  been  so  rapid, 
during  the  last  half-century,  as  to  arouse  alarm. 
In  England,  from  1849  to  l%94>  the  insane  popula- 
tion nearly  quadrupled,  while  the  total  population 
hardly  doubled.  In  Scotland,  between  1859  anc* 
1894,  the  number  of  insane  persons  to  every  hun- 
dred thousand  of  population  rose  from  192  to  325 — 
an  increase  of  seventy  per  cent,  in  the  frequency  of 
its  occurrence.  In  Ireland,  during  thirty  years 
(1862-1892),  the  population  diminished  by  twenty 
per  cent.,  while  the  actual  number  of  the  insane 

IO 

145 


146  Sanity  of  Mind 

more  than  doubled.  In  Massachusetts,  during  fif- 
teen years  (1878-1893),  the  resident  insane  increased 
annually  six  per  cent.,  while  the  general  population 
gained  only  about  three  per  cent. 

These  figures  present  the  affirmative  view  in  a 
strong  light.1  It  is  but  fair  to  say  that  strong  argu- 
ments have  been  offered  upon  the  other  side  also. 
The  Scotch  Lunacy  Commission,  in  a  supplementary 
Report,  December  21,  1894,"  point  out  that  a  rapid 
increase  in  the  registered  insane  population  follows 
the  erection  of  new  asylums;  that  popular  feeling  in 
favor  of  asylum  treatment  is  increasing;  that  a  con- 
tinually wider  circle  is  included  in  the  enlarging 
definition  of  insanity.  A  special  report  from  the 
English  Commissioners  in  Lunacy,  February  22, 
1897,  takes  similar  ground. 

A  part  of  the  apparent  increase  has  been  unques- 
tionably due  to  the  increase  of  accuracy  in  census- 
taking,  and  the  increased  facilities  for  receiving 
patients  in  hospitals  —  a  case  where  the  market 
creates  the  supply.  As  Clouston  says:  "Admis- 
sion to  hospitals  for  the  insane  will  increase  for 
many  years  to  come,  not  from  any  positive  increase 
of  insanity  at  all,  but  from  a  more  extended  realiza- 
tion by  society,  of  every  grade,  of  the  benefit  and 
convenience  of  such  hospitals."  Another  part  of 

1  From  article  by  Mr.  F.  B.  Sanborn  in  the  New  Haven  Confer- 
ence of  Charities,  May,  1895. 

8  Compare  the  article  on  "  Statistics  of  Insanity,"  by  Dr.  Tuke,  in 
the  Dictionary  of  Psychological  Medicine,  especially  remarks  on 
ratio  of  first  attacks  to  total  population. 


Our  Social  and  Civic  Duties      147 

the  increase  is  due  to  the  better  care  taken  of  the 
insane,  which  greatly  prolongs  their  lives  and  pro- 
duces a  large  accumulation  of  chronic  incurable 
cases.  It  is  remarkable,  however,  that  the  increase 
seems  to  be  still  rapid  at  the  end  of  the  nineteenth 
century,  after  more  than  a  hundred  years  of  im- 
provements in  care  and  treatment.  The  weight  of 
evidence  seems  to  lean  in  favor  of  an  increasing 
proportion,  both  of  the  insane  in  bulk  and  of  the 
number  of  new  cases  occurring  yearly. 

The  degeneracy  of  various  kinds  traceable  in  the 
human  race  is  so  frightful  in  amount  that  any  means 
within  reach  should  be  seized  upon  to  lessen  it. 
The  proposal  has  been  seriously  made  to  revert  to 
the  customs  of  the  old  Spartans  and  put  to  a  hu- 
mane death  all  the  defectives,  in  order  to  eliminate 
pro  tanto  the  possibility  of  their  defects  mingling  by 
descent  with  the  strain  of  normal  humanity. 

Whatever  may  be  the  arguments  in  favor  of  this 
proposal,  it  may  be  said  that  there  are  too  many 
people  who  believe  in  "  the  right  to  live  "  to  permit 
its  serious  consideration.  Among  legislators  and 
their  constituents  there  are  few  who  are  not  con- 
scious of  defect  within  themselves,  or  within  the 
circle  of  family  and  friends;  all  are  bound  by  the 
personal  tie.  Besides  which  there  is  a  feeling  that 
we  have  not  yet  tried  all  means  —  we  do  not  yet 
know  what  may  be  done  in  the  case  of  insanity, 
and  still  more  in  that  of  crime,  to  relieve  or  cure 
the  victims.  There  are,  however,  less  stringent 
measures, — expensive,  indeed,  but  humane  and  just, 


148  Sanity  of  Mind 

— admittedly  binding  on  the  government,  which  if 
carried  out  would  greatly  lessen  the  number  of 
defectives  born.  I  refer  in  the  first  instance  to  the 
custodial  care  of  the  classes  known  as  the  insane, 
the  feeble-minded  or  idiotic,  the  epileptic,  inebri- 
ates, criminals,  tramps,  and  paupers.  In  each  class 
the  object  should  be  to  restrict,  or  wholly  prevent, 
the  propagation  of  a  new  generation. 

The  following  data  are  given  by  the  United  States 
Census  for  1890: 

Insane 106,485 

Feeble-minded  and  idiotic 95,609 

Prisoners 82,329 

Juvenile  delinquents 14,846 

Paupers  in  almshouses 73,045 

The  first  two  of  these  data  are  unquestionably 
much  below  the  truth,  for  reasons  explained  by  the 
editor  of  the  census.  As  regards  the  feeble-minded 
there  is  doubtless  a  special  reluctance  in  many  cases 
to  state  the  harsh  truth  in  regard  to  one's  relatives. 

An  estimate  is  here  offered  for  1900,  as  follows: 

Insane 180,000 

Feeble-minded  and  idiotic 200,000 

Epileptic 130,000 

See  remarks  in  the  Appendix. 

The  educative  forces  of  the  community,  the  re- 
ligious forces,  the  police,  punitive,  and  reformatory 
forces,  the  forces  working  for  sanitary  improvement 
and  the  relief  of  poverty,  are  all  combating  the  evils 


Our  Social  and  Civic  Duties      149 

in  which  insanity  is  rooted.  The  philanthropic 
aspect  of  the  problem  is  obvious.  Its  economic 
side,  however,  is  beginning  to  come  more  promi- 
nently into  view.  It  is  an  enormous  question, 
involving  the  custodial  care  of  half  a  million,  and 
perhaps  more,  of  the  insane,  the  feeble-minded,  and 
the  epileptic  —  not  to  speak  of  the  inebriates. 

From  data  drawn  by  Mr.  F.  B.  Sanborn  l  from 
the  State  Board  of  Charities'  report,  it  appears  that 
in  Massachusetts  insanity  is  the  most  important  of 
all  the  causes  of  permanent  pauperism.  In  1864,  of 
the  total  number  fully  dependent  upon  public  sup- 
port, one  in  four  was  insane,  and  this  ratio  has  been 
increasing  until  in  1895-1898  it  was  more  than  one 
in  two! 

While  asylums,  in  the  old  sense  of  the  word,  con- 
tinue to  have  their  use,  considered  as  hospitals,  it 
has  become  obvious  of  late  years  that  there  are 
better  and  more  economical  ways  of  caring  for  a 
large  part  of  the  cases.  The  acutely  insane  are 
usually  sick  people,  often  requiring  careful  nursing. 
After  this  stage  is  passed,  very  many  can  be  placed 
in  "  cottages,"  or  buildings  of  moderate  size  adapted 
to  ordinary  life,  containing  (as  at  the  celebrated  Alt- 
Scherbitz  establishment)  from  ten  to  thirty  resi- 
dents, among  whom  the  family  feeling  is  cultivated. 
The  establishment  of  chronic  patients  on  a  farm, 
under  the  direction  of  one  or  two  practical  farmers, 
has  proved  a  financial  success  under  the  direction  of 
the  Utica  asylum. 

1  Charities  Review,  December,  1898. 


150  Sanity  of  Mind 

The  village  of  Gheel,  in  Belgium,  where  the  harm- 
less class  of  insane  are  permanently  boarded  among 
the  farmers,  one  or  two  in  a  house,  forming  a  part 
of  the  family  and  sharing  in  its  labors,  has  been  the 
centre  of  a  great  deal  of  scientific  curiosity,  and  it 
may  be  said  to  have  borne  the  test  well.  In  Bel- 
gium there  now  exists  a  second,  much  smaller  village 
establishment  at  Lierneux,  in  the  southern  part  of 
the  kingdom,  conducted  in  the  same  way  as  Gheel. 
France  has  one  with  five  hundred  patients  at  Dun- 
sur-Auron  in  Berri,  founded  in  1891.  Something 
similar  has  been  established  in  villages  near  Bremen 
and  Hamburg.  Scotland  has  a  similar  plan,  but 
prefers  to  distribute  the  boarders  among  a  large 
number  of  different  villages.1 

The  existence  of  a  chronic  state  of  crowding,  with 
disgraceful  lack  of  accommodation,  in  most  of  our 
State  asylums,  is  a  curious  parallel  to  the  failure  of 
our  great  municipalities  to  keep  pace  with  the  in- 
crease in  their  school  population.  An  increased 
activity  of  the  public  conscience  will  doubtless  lead 
to  a  remedy  of  both  conditions.  It  is  worth  while 
to  care  for  the  insane.  For  the  new  cases,  hardly 
any  amount  of  attention,  medical,  physical,  and 
by  way  of  nursing,  can  be  too  great  while  the 
chances  of  recovery  are  still  large.  For  a  very  large 
mass  of  cases  fully  diagnosticated,  long  treated,  but 
continuing  in  an  unprogressive  or  declining  state, 
the  Gheel  system,  the  Scotch  method,  and  the  farm 

1  A  good  account  of  these  peculiar  village  establishments  is  given 
by  Toulouse,  Les  Causes  de  la  Folie,  1896. 


Our  Social  and  Civic  Duties      151 

colony  furnish  conditions  of  life  which  are  far 
more  pleasing  to  the  patient,  because  more  in  the  line 
of  human  life,  than  asylums  can  possibly  be,  and  un- 
questionably more  conducive  to  mental  improve- 
ment. The  superior  economy  of  these  methods  will 
soon  cause  their  general  adoption  for  patients  of  this 
class. 

It  is  admitted  by  all  who  have  to  treat  the  insane 
that  many  cases  apply  for  treatment  too  late ;  that 
there  is  a  strong  tendency  on  the  part  of  the  public 
to  put  off  the  necessary  but  painful  step  of  a  medi- 
cal inquest,  so  that  the  period  of  the  disorder  in 
which  it  is  most  easily  controlled  is  neglected,  and 
not  a  few  cases  are  permitted  to  run  into  positive 
insanity  which  could  have  been  checked  if  attended 
to  earlier. 

Dr.  Frederick  Peterson  of  New  York  has  pro- 
posed the  establishment  of  certain  institutions,  to 
be  known  as  "  Psychopathic  Hospitals,"  to  which 
those  who  show  tendencies  to  acute  derangement 
may  be  taken  in  the  early  stages,  without  waiting 
for  the  symptoms  to  become  so  marked  as  to  justify 
the  physician  in  declaring  them  insane.  The  sick 
may  be  sent  to  such  hospitals  on  the  simple  request 
of  an  attendant  physician,  just  as  would  be  done  in 
ordinary  cases  of  sickness,  and  may  be  kept  under 
care  for  a  fortnight,  during  which  time  either  con- 
valescence may  occur,  or  the  disease  may  develop 
into  forms  requiring  asylum  care.  In  his  plan,  the 
State  is  to  be  asked  to  build  and  support  one  such 
hospital  in  each  of  the  largest  cities. 


152  Sanity  of  Mind 

Dr.  Hurd  has  recently '  urged  the  establishment 
of  such  "  detention  hospitals,"  and  also  of  out- 
patient departments  for  the  treatment  of  insanity 
by  alienists.  He  believes  that  many  cases  of  neu- 
rasthenia or  melancholia  might  be  thus  treated  in 
the  beginning  of  their  disorders  and  cured  without 
needing  to  enter  an  asylum. 

The  dread  of  an  "  institution  "  keeps  many  from 
receiving  early  treatment  which  might  save  them 
from  a  severe,  perhaps  incurable  mental  disorder. 
The  modern  methods,  being  more  natural,  are  help- 
ing to  break  up  this  superstitious  feeling.  It  is 
pleasant  to  be  able  to  mention  that  at  the  present 
time  one  half  of  the  inmates  at  McLean  Insane 
Hospital  came  by  their  own  application. 

Dr.  Stephen  Smith  of  New  York,  during  his  con- 
nection with  the  State  insane  asylums  in  the  char- 
acter of  State  Commissioner,  took  occasion  to  urge 
the  introduction  of  a  feature  which  in  some  ways 
would  have  been  the  equivalent  of  Dr.  Peterson's 
plan.  His  proposal  was,  that  each  patient  on  ad- 
mission should  be  isolated  from  the  insane  and  be 
placed  in  a  separate  room,  under  the  charge  of  a 
competent  attendant  devoted  especially  to  him  and 
selected  with  reference  to  adaptedness  to  the  pa- 
tient's education  and  character;  that  for  a  certain 
time,  perhaps  a  week,  this  special  oversight  should 
be  kept  up  with  a  view  to  a  careful  study  of  symp- 
toms; meanwhile  winning  the  patient 's  confidence 
and  ascertaining,  if  possible,  the  cause  of  the  attack, 

1  American  Journal  of  Insanity ,  vol.  Ivi.,  No.  2,  1899. 


Our  Social  and  Civic  Duties      153 

as  far  as  it  might  be  of  a  psychical  nature — a  delu- 
sion, for  example.  The  increased  expense  of  this 
system  might  be  expected  to  be  balanced  by  the  sav- 
ing of  a  certain  number  of  persons  from  prolonged 
illness  or  permanent  dementia ;  to  say  nothing  of  the 
point  of  humanity. 

Dr.  Smith  illustrates  his  position  by  an  experience 
of  his  own.  While  officially  visiting  one  of  the  in- 
stitutions for  the  insane,  his  attention  was  called  to 
a  man,  recently  admitted,  whose  frantic  behavior 
disturbed  the  whole  ward.  The  doctor  determined 
to  see  how  far  he  could  influence  the  man  by  a 
private  interview.  Taking  him  aside,  he  privately 
and  significantly  hinted  at  the  possibility  of  his 
getting  out  of  the  asylum  "  if  he  would  do  exactly 
as  directed."  Using  this  motive,  he  gradually 
calmed  the  man's  wild  explosions,  and  by  degrees 
got  him  to  tell  what  brought  him  to  that  place  — 
money  difficulties,  and  a  fixed  idea  of  his  wife's 
infidelity.  A  stern  and  absolute  denial  of  the  possi- 
bility of  the  latter  was  again  and  again  urged,  until 
the  man  could  no  longer  maintain  it,  and  broke 
down  in  tears  and  submission.  He  was  then  strictly 
warned  by  Dr.  Smith  to  be  on  his  very  best  behavior 
for  the  few  days  following,  and  to  write  suitable 
apologies  to  those  wronged  by  his  suspicions.  No 
intimation  of  all  this  was  given  to  the  authorities ; 
but  on  the  doctor's  next  visit  he  learned  that  the 
man  had  behaved  so  absolutely  sanely  that  he  was 
discharged  in  a  few  days.  He  remained  sane. 

There  can  be  no  doubt  that  this  "  mental  "  or 


154  Sanity  of  Mind 

"  suggestive  "  treatment  would  have  been  infinitely 
more  difficult  a  fortnight  later.  At  some  point  of 
time,  we  must  suppose,  such  cases  pass  into  a  defin- 
itive condition  of  insanity,  in  which,  both  legally 
and  clinically,  they  have  to  be  set  apart  from  other 
men.  Yet  even  after  the  disease  has  fully  declared 
itself  the  mental  influences  which  can  be  brought  to 
bear  are  many./  Relief  from  the  pressure  of  one's 
neighbors  and  kin  is  to  many  an  irritated  and  sus- 
picious mind  a  blessing,  and  a  positively  sanative 
agent.  I  The  sympathetic,  impressive  presence  of  a 
physician  is  a  great  help  to  a  mind  in  need  of  guid- 
ance. 

The  need  of  minute  individualization  is  more 
urgent  in  insanity,  especially  in  regard  to  its  psy- 
chical side,  than  in  any  other  complaint,  as  has  been 
pointed  out  by  Griesinger  and  Krafft-Ebing.  If  we 
are  to  have  psychical  treatment  of  an  intelligent  sort 
—  not  that  of  routine  and  mechanism  —  we  need  a 
great  deal  of  direct  personal  contact  between  physi- 
cian and  patient.  It  appears  not  unlikely  that  this 
class  of  influences  is  destined  to  occupy  the  profes- 
sional mind  more  than  heretofore  in  relation  to  all 
the  psychoses. 

In  promoting  the  recovery  of  the  insane,  and  in 
providing  for  their  welfare  after  discharge,  an  op- 
portunity for  a  most  beneficial  work  analogous  to 
that  of  the  "  prisoner's  friend  societies  "  lies  open 
to  the  philanthropic.  In  Europe  the  "  socie'te's  de 
patronage,"  or  guardian  societies,  are  firmly  estab- 
lished; Dr.  Jules  Morel  mentions  about  twenty  of 


Our  Social  and  Civic  Duties      155 

them  in  his  article  in  the  Twenty-Sixth  National 
Conference  of  Charities  Report.  See  article  by  the 
same  writer  on  "  Prophylaxis  of  Mental  Diseases," 
in  American  Journal  of  Psychology,  vol.  v.,  No.  I, 
1899. 

The  first  weeks  after  discharge  from  an  asylum, 
when  its  shelter  and  support  are  withdrawn  from 
one  perhaps  not  quite  fitted  to  face  a  coldly  ques- 
tioning world,  may  be  of  critical  importance  in  / 
determining  the  final  outcome.  No  more  truly 
Christian  act  can  be  named  than  friendly  sympathy 
given  at  that  time.  Such  attentions  form  a  part  of 
the  work  of  the  societies  I  have  described. 

The  Craig  Colony  for  Epileptics,  at  Sonyea,  N. 
Y.,  is  one  of  the  most  prominent  of  recent  attempts 
to  improve  the  condition  of  that  class.  It  occupies 
a  large  tract  purchased  from  the  Shakers,  and  aims 
to  occupy  the  inmates  with  farming,  housework, 
and  to  some  extent  with  trades,  replacing  drug- 
treatment  by  abundant  physical  exercise.  The 
original  of  the  idea  was  found  in  the  great  establish- 
ment at  Bielefeld  in  Germany,  founded  by  Pastor 
von  Bodenschwingh.1  The  institution  is  intended 
for  one  thousand  patients  when  completed.  Seven  \ 
were  discharged  as  cured,  /.  <?.,  as  having  had  no 
attack  during  two  years,  in  the  year  ending  Sep- 
tember, 1898. 

A  recommendation  was  made  in  the  Craig  Colony 

1  See  Care  and  Treatment  of  Epileptics,  by  Wm.  Pryor  Letchworth, 
1900 ;  also  A  Colony  of  Mercy,  by  Julie  Sutler,  which  describes 
Bielefeld. 


156  Sanity  of  Mind 

report  for  1898  in  favor  of  giving  some  small  com- 
pensation to  patients  whose  services  exceed  the  cost 
of  their  keep.  The  English  have  adopted  a  system 
of  this  kind  in  Broadmoor  State  Criminal  Asylum, 
and  find  it  a  financial  success.1 

The  insane  are  commonly  reckoned  as  about  three 
.f  * 

( in  one  thousand  of  the  general  population ;  the 
idiotic  and  feeble-minded  may  not  number  as  many, 
but  if  the  "  backward  "  are  taken  in,  the  class  is 
trebled. 

The  number  of  feeble-minded  in  institutions  in 
the  United  States  is  very  small  compared  with 
those  at  large  in  the  community  —  perhaps  one  six- 
teenth. An  enormous  work  remains  to  be  done  in 
this  direction,  and  one  which  promises  to  do  more 
for  the  suppression  of  degeneracy  than  any  other 
measure  likely  to  be  undertaken.  The  very  idea  of 
marriage  between  persons  of  this  class  is  frightful. 
No  morbid  entailment  is  more  certain  than  that  of 
a  feeble  mind  in  the  progeny  of  this  class;  and  yet 
such  marriage  is  generally  permitted  to  take  place  in 
the  absence  of  State  laws  forbidding  it.  There  is 
such  a  status  as  feeble-mindedness,  as  deadly  to  the 
hopes  of  posterity  as  syphilis,  but  differing  from 
the  latter  in  being  absolutely  incurable;  for,  how- 
ever much  we  may  do  to  train  feeble  minds,  we 
can  never  bring  their  native  powers  to  a  normal 
grade. 

This  class  of  the  population  should  be,  one  and 

1  Mercier,  Lunatic  Asylums  :  Their  Organization  and  Manage- 
ment, p.  90. 


Our  Social  and  Civic  Duties      157 

all,  brought  within  enclosures,  educated,  and  kept  in 
celibacy  as  State  wards  during  their  lifetime.  Some 
will  always  remain  mere  animals,  helpless  and  incap- 
able. A  considerable  part,  however,  can  be  so 
brought  up  as  to  be  physically  strong  enough  to 
enjoy  rough  labor :  these  can  be  colonized,  as  the 
State  of  Massachusetts  is  now  seeking  to  do  with  a 
certain  number  of  adult  men,  for  whose  use  a  tract 
of  three  square  miles  has  been  purchased  in  a  rough, 
uncleared  country,  where  they  may  live  as  pioneers 
and  farmers.  Similar  measures  have  been  adopted 
by  Wisconsin,  California,  and  Ohio.  A  compara- 
tively small  part  are  enabled  to  earn  their  living  in 
trades :  it  is  these  that  give  the  most  anxiety,  lest 
they  marry  and  continue  their  breed. 

The  feeble-minded  are  often  exceedingly  difficult 
to  deal  with  at  home.  They  are  apt  to  be  restless, 
mischievous,  strange-tempered,  and  a  menace  to  the 
peace,  even  the  lives,  of  those  they  are  with.  It 
may  be  reckoned  that  every  such  child  brought  into 
an  asylum  sets  free  two  or  three  adults  from  a  griev- 
ous burden,  which  doubtless  has  often  contributed 
to  drive  the  mother  into  insanity. 

Of  all  classes  of  women  the  feeble-minded  are 
those  most  in  need  of  protection. 

A  feeble-minded  girl  is  exposed  as  no  other  girl  in  the 
world  is  exposed.  She  has  not  sense  enough  to  protect 
herself  from  the  perils  to  which  women  are  subjected. 
Often  bright  and  attractive,  if  at  large  they  either  marry 
and  bring  forth  in  geometric  ratio  a  new  generation  of 
defectives  and  dependents,  or  become  irresponsible 


158  Sanity  of  Mind 

sources  of  corruption  and  debauchery  in  the  community 
where  they  live.     [W.  E.  Fernald.] 

Bearing  in  mind  that  the  feeble-minded  are  prob- 
ably as  numerous  as  the  insane ;  that  only  a  probable 
six  per  cent,  of  them  are  guarded  in  special  institu- 
tions; that  of  the  rest  large  numbers  are  in  poor- 
houses,  or  jails,  or  tramping,  with  the  exposures 
implied,  we  cannot  wonder  at  the  statement  that  a 
very  large  proportion  of  the  illegitimate  children  are 
the  offspring  of  this  class.1 

The  broad  outlook  of  the  following  citation  "  will 
justify  its  presence  here : 

There  is  no  field  of  political  economy  which  can  be 
worked  to  better  advantage  for  the  diminution  of  crime, 
pauperism,  and  insanity,  than  that  of  idiocy.  The  early 
recognition  of  some  of  its  special,  upper,  and  more  danger- 
ous forms  should  be  followed  by  their  withdrawal  from 
unwholesome  environments  and  their  permanent  seques- 
tration before  they  are  pronounced  criminals  and  have, 
by  the  tuition  of  the  slums,  acquired  a  precocity  that  de- 
ceives even  experts.  Only  a  small  percentage  should 
ever  be  returned  to  the  community,  and  then  only  under 
conditions  that  would  preclude  the  probability  of  their 
assuming  social  relations  under  marriage,  or  becoming 
sowers  of  moral  and  physical  disease  under  the  garb  of 
professional  tramps  and  degraded  prostitutes.  How 
many  of  your  criminals,  inebriates,  and  prostitutes  are 

1  "  The  majority  of  the  imbeciles  who  owe  their  defectiveness  to 
heredity  are  born  outside  the  marriage  relation." — Charities  Review, 
June,  1899,  p.  192. 

8  Dr.  Kerlin,  National  Conference  Charities  and  Correction,  1884. 


Our  Social  and  Civic  Duties      159 

congenital  imbeciles!  How  many  of  your  insane  are 
really  feeble-minded  or  imbecile  persons,  wayward  and 
neglected  in  their  early  training,  and  at  last  conveniently 
housed  in  hospitals,  after  having  wrought  mischief,  en- 
tered social  relations,  reproduced  their  kind,  defied  law, 
antagonized  experts  and  lawyers,  puzzled  philanthropists, 
and  in  every  possible  manner  retaliated  on  their  progeni- 
tors for  their  origin,  and  on  the  community  for  their  mis- 
apprehension!  How  many  of  your  incorrigible  boys, 
lodged  in  the  houses  of  refuge,  to  be  half  educated  in 
letters  and  wholly  unreached  in  morals,  are  sent  out  into 
the  community  the  moral  idiots  they  were  at  the  begin- 
ning, only  more  powerfully  armed  for  mischief!  And 
pauperism  breeding  other  paupers,  what  is  it  but  im- 
becility let  free  to  do  its  mischief  ? 

There  are,  however,  those  whose  social  antecedents 
lift  them  above  the  classes  which  we  have  just  de- 
scribed. Ireland  has  the  following  to  say  of  these : 

I  have  seen  individuals  who  had  sufficient  mental 
power  to  pass  college  examinations,  take  degrees,  and 
even  gain  prizes,  who  were  so  manifestly  unfit  to  con- 
duct themselves  in  the  ordinary  affairs  of  life,  that  they 
were  a  laughing-stock  to  the  most  ignorant  people 
around  them.  Most  of  the  imbeciles  described  by 
Tre'lat  in  his  striking  book,  La  Folie  Lucide,  are  simple- 
minded  people,  often  with  a  tinge  of  insanity.  Imbecile 
girls  not  unfrequently  find  husbands  in  France,  where 
the  marriages  are  arranged  by  the  parents,  and  a  dowry 
will  make  almost  any  young  woman  pass  muster  in  the 
matrimonial  market.  I  knew  of  an  instance  of  the  kind 
myself  when  living  at  Avignon.  Tre'lat  portrays,  in  an 


160  Sanity  of  Mind 

eloquent  and  touching  manner,  the  misery  of  such  con- 
nections, which  often  hand  down  the  curse  of  imbecility 
or  insanity  to  another  generation.  Dickens  has,  in 
David  Copper  field,  given  a  beautiful  picture  of  an  imbe- 
cile girl,  whose  tender  and  loving  nature  gained  the 
heart  of  an  inexperienced  and  imaginative  young  man.1 

Most  of  the  inmates  of  our  institutions  for  feeble- 
minded are  likely  to  remain  there  for  life.  There 
are  cases  in  which  exceptions  may  properly  be  made. 
The  matter  of  self-support  may  be  considered  im- 
portant. A  young  person  who  has  been  trained  to 
orderly  and  moral  habits  may  be  thus  placed  in  his 
or  her  own  family,  or  otherwise,  if  found  suitable. 
Ireland  considers  that  very  few  so  placed  are  likely 
to  think  of  marriage. 

The  weak-minded  do  not  appreciate  the  ordinary 
motives  for  controlling  their  sexual  passions  as 
others  do.  Their  lack  of  self-control  in  this  respect 
is  often  a  source  of  great  annoyance  to  those  who 
have  them  in  charge,  and  of  injury  to  themselves. 
Experience  has  shown  the  immense  importance  of 
bringing  them  up  in  the  practice  of  hard  bodily 
work,  enough  every  day  thoroughly  to  fatigue  them 
and  bring  sound  sleep.  If  this  plan  can  be  carried 
out  consistently,  under  the  eye  of  the  institution, 
and  supplemented  by  transfer  to  agricultural  colonies 
when  adult  age  is  reached,  the  best  thing  is  probably 
done  for  the  welfare  of  the  unfortunate  defective. 

But  there  is  another  view,  which  is  urged  by  the 

1  W.  W.  Ireland,  The  Menial  Affections  of  Children,  1898,  p.  339. 


Our  Social  and  Civic  Duties      161 

weight  of  much  authority.  For  the  protection  of 
society  against  untoward  accidents,  it  is  widely  be- 
lieved that  sterilization  or  castration  should  be  per- 
formed, at  all  events  upon  boys,  where  it  is  expected  : 
that  they  are  to  be  brought  back  from  school  into 
their  family  or  into  society,  as  is  occasionally  de- 
sired. The  consent  of  parents  or  guardians  must 
always  be  obtained. 

I  am  permitted  to  insert  the  following  statement, 
made  by  the  gentleman  whose  name  appears  and 
who  has  taken  a  strong  professional  interest  in  the 
question: 

In  three  cases,  Dr.  W.  W.  Keen  of  Philadelphia  has 
castrated  boys  so  idiotic  and  feeble-minded  that  they 
could  never  be  responsible  for  their  actions.  In  such 
boys  the  sexual  appetite  is  sometimes  exceedingly  strong 
(as  was  the  case  in  two  of  the  three  instances  cited)  and 
might  easily  lead  them  to  do  harm  to  young  women 
without  being  morally  responsible  for  it,  or  might  render 
them  liable  to  become  the  victims,  of  designing  women 
who  might  wish,  in  case  of  well-to-do  or  wealthy  parents, 
practically  to  levy  blackmail.  It  is  also  very  undesir- 
able that  such  boys  should  ever  have  any  children  who  i 
would  be  similarly  weak-minded. 

Of  course  in  each  instance  the  hearty  co-operation 
and  consent  of  the  parents  had  been  secured  before  the 
operation. 

It  is  well  in  these  cases  to  defer  operation  until  after 
the  change  in  the  boy's  voice,  so  that  there  would  be  no 
such  obvious  evidence  of  the  operation  as  would  other- 
wise exist. 


162  Sanity  of  Mind 

It  is  a  question  whether  a  similar  operation  (the  re- 
moval of  the  ovaries)  should  not  be  done  in  the  case  of 
girls  of  similar  weak  minds,  of  course  with  the  full  con- 
sent of  their  parents. 

A  considerable  number  of  cases  have  thus  been 
operated  upon  in  the  Michigan  Home  for  the 
Feeble-minded  and  Epileptic,  with  the  result  of 
improving  the  moral  status.  A  small  number  of 
epileptic  boys,  whose  condition  and  habits  rendered 
them  practically  unmanageable,  were  operated  on  at 
Monson,  Mass.,  with  results  which  were  considered 
very  favorable.  At  a  similar  institution  in  Kansas, 
much  popular  objection  was  raised  against  the  opera- 
tion, upon  apparently  good  grounds  quite  apart  from 
the  scientific  merits  of  the  question. 

The  question  of  applying  this  operation  to  the 
feeble-minded  is  practically  new,  and  cannot  be 
regarded  as  settled  in  all  its  bearings.  If  defective 
young  men  are  to  be  brought  "  into  society,"  with 
its  temptations  and  its  artificial  idleness,  to  gratify 
the  irrational  wishes  of  parents,  the  dangers  indi- 
cated by  Dr.  Keen  become  a  matter  for  serious 
consideration,  and  may  well  be  guarded  against  by 
following  his  suggestion.  Where,  however,  it  is 
feasible  to  keep  the  patient  under  custodial  observa- 
tion from  childhood  up,  in  rural  surroundings,  with 
wise  educational  treatment  and  abundant  hard  labor, 
it  seems  to  me  consistent  with  his  best  welfare  to 
dispense  with  the  operation.  This  would  doubtless 
be  equally  true  of  the  sons  of  the  rich. 

The  merits  of  the  operation  of  ovariotomy,  in  the 


Our  Social  and  Civic  Duties       163 

present  connection,  are  much  in  question,  and  the 
results  are  often  disappointing.  Some  very  serious 
consequences  have  been  noted,  including  insanity. 
In  a  general  way  it  may  be  added  that,  while  the 
woman  is  indeed  rendered  incapable  of  bearing 
children,  her  passions  are  not  lessened,  and  her 
power  of  doing  moral  mischief,  if  so  inclined,  is 
increased;  in  fact,  un-moral  weak-minded  persons 
have  been  known  to  accept  the  condition  as  a  sort 
of  free  license  to  transgress. 

Marriage  is  a  civic  function,  in  which  the  citizen 
enters  on  a  new  relation  to  the  state.  The  state 
makes  the  parent  responsible  for  the  maintenance 
and  the  morals  of  his  offspring,  and  it  has  the  im- 
plied right  (though  scarcely  recognized  by  statute) 
to  expect  that  the  offspring  be  well  born.  At 
present  most  of  the  responsibility  for  this  must  be 
borne  by  the  citizen  as  an  individual.  If  we  are  to 
have  laws  against  the  marriage  of  defectives,  a  pub- 
lic sentiment  must  precede  their  enactment. 

As  regards  the  marriage  relations  of  the  insane, 
and  the  special  statutory  regulation  of  marriage 
with  a  view  to  lessen  morbid  inheritance,  there  is 
room  for  some  difference  of  opinion.  It  has  been 
suggested  that  the  existence  of  insanity,  or  even  of 
epilepsy  or  drunkenness,  in  either  party,  should  be  a 
bar  to  marriage  when  the  woman  is  within  the  sup- 
posed age  of  child-bearing,  i.  e.,  under  forty-five. 
It  is  obvious  that  there  might  be  difficulty  in  dis- 
criminating in  such  cases,  and  that  hardship  or  in- 
jury to  interests  might  arise.  The  marriage  of  the 


1 64  Sanity  of  Mind 

clearly  feeble-minded  is  not  likely  to  occur  among 
the  educated  classes,  but  a  deterrent  penalty  ought 
to  be  affixed  for  the  sake  of  society  at  large. 

The  Connecticut  law  of  1895  forbids,  under  pen- 
alty of  three  years'  imprisonment,  the  marriage, 
where  the  woman  is  under  forty-five  years  of  age,  of 
a  man  and  woman  either  of  whom  is  epileptic,  im- 
becile, or  feeble-minded. 

A  Pennsylvania  law  inflicts  the  penalty  of  six 
months'  imprisonment  or  $500  fine  or  both  on  per- 
sons knowingly  celebrating,  procuring,  or  abetting 
the  marriage  of  the  insane  or  feeble-minded,  or  of 
one  insane  in  the  past  from  natural  as  distinguished 
from  accidental  causes;  the  same  penalty  for  the 
principals. 

There  are  certain  things  which  the  contracting 
parties  to  a  marriage  have  a  right  to  know,  and  the 
concealment  of  which  attaches  bad  faith  to  the  party 
who  conceals.  There  is  nothing  which,  it  should 
seem,  the  engaged  party  has  a  better  right  to  know 
than  the  fact  of  the  other  party's  having  formerly 
been  insane,  or  syphilitic,  or  epileptic ;  and  it  is  ap- 
parent justice  that  the  concealment  of  such  facts 
should  form  cause  of  annulment  of  marriage. 

Drunkenness  is  recognized  as  a  very  prolific  source 
of  mental  and  bodily  degeneracy,  including  insanity. 
While  it  is  certainly  true  that  many  cases  of  intem- 
perance are  due  to  a  morbid  inheritance,  it  is  also 
true  that  the  drinking  habit  is  largely  within  the 
reach  of  control  by  judicious  legislation.  Leaving 
the  question  of  restriction  upon  sales  undiscussed, 


Our  Social  and  Civic  Duties      165 

we  find  that  the  manner  of  the  infliction  of  the  usual 
penalty  for  drunkenness  is  open  to  serious  objec- 
tions, as  fostering  and  fixing  the  habit  rather  than 
breaking  it  up.  In  Massachusetts,  at  the  present 
time,  it  is  in  the  power  of  the  courts  to  sentence  a 
person  to  confinement  in  asylums  for  inebriety,  as  is 
done  in  insanity :  the  principle  of  compulsory  State 
treatment  of  diseases  dangerous  to  the  public  health 
has  thus  been  made  to  apply  to  this  eminently  dan- 
gerous disorder,  with  satisfactory  results.  Elsewhere 
in  the  United  States,  commitment  of  inebriates  is 
made  by  criminal  procedure. 

No  permanently  good  condition  can  exist  in 
asylums,  reformatories,  and  prisons  while  they  are 
allowed  to  remain  subject  to  the  caprice  of  spoil- 
seeking  partisanship.  It  is  the  plain  duty  of  all 
good  citizens  to  unite  in  keeping  these  institutions 
out  of  the  reach  of  those  corrupt  conditions  popu- 
larly called  "  politics,"  which  at  this  very  moment 
are  inflicting  disgrace  upon  the  administration  of 
many  States. 


APPENDIX 

I.    WORKS  ON  THE  PREVENTION  OF  INSANITY 

THE  following  works,  of  a  more  or  less  popular  char- 
acter, have  fallen  in  the  way  of  the  author.     The 
list  does  not  profess  to  be  complete. 

BARLOW,  JOHN.  On  Man's  Power  over  Himself  to  Pre- 
vent or  Control  Insanity.  Communicated  to  the 
members  at  the  Royal  Institution  of  Great  Britain, 
May  26,  1843.  London  :  Wm.  Pickering. 

BLANDFORD,  GEORGE  FIELDING.  "  Insanity,"  in  vol. 
xii.  of  Twentieth  Century  Practice  of  Medicine ;  see 
section  on  "Prevention,"  pp.  221-235. 

FEUCHTERSLEBEN,  ERNST,  FREIHERR  VON  (died  1849). 
Zur  Didtetik  der  Seele  ;  also  (translation),  The  Die- 
tetics of  the  Soul,  edited  from  the  seventh  edition. 
C.  S.  Francis  &  Co.,  1854. 

JACOBI,  MARY  PUTNAM.  "  The  Prevention  of  Insanity, 
and  the  Early  and  Proper  Treatment  of  the  Insane," 
Journal  of  Social  Science,  No.  xv.,  1882. 

MAUDSLEY,  HENRY.  The  Pathology  of  Mind:  being 
the  third  edition  of  the  second  part  of  the  "  Physiology 
and  Pathology  of  Mind"  recast,  enlarged,  and  re- 
written. 1880.  See  Chapters  III.,  IV.,  and  V.  on 
the  "  Causation  and  Prevention  of  Insanity,"  pp. 
82-225. 

167 


i68  Sanity  of  Mind 

MERCIER,    CHARLES    ARTHUR.      Sanity    and   Insanity. 

("  Contemporary  Science  Series.")     1890. 
RAY,  ISAAC.     Mental  Hygiene.     1863. 
STEARNS,  HENRY  PUTNAM.     Insanity:  Its  Causes  and 

Prevention.     1883. 
TUKE,  DANIEL  HACK.     Insanity  in  Ancient  and  Modern 

Life,  with  Chapters  on  its  Prevention.     1878. 

II.  CHARACTER  AS  DETERMINED  BY  ENVIRONMENT 
OR  HEREDITY 

(Page  39) 

A  series  of  articles,  with,  the  title  "  Environment  ver- 
sus Heredity,"  by  several  leading  experts  in  institutional 
work,  appeared  in  the  Charities  Review  for  1899.  The 
conclusions  are  of  value  as  being  the  result  of  experience, 
and  are  probably  fairly  representative  of  the  opinion  of  a 
majority  of  this  class  of  workers  in  our  own  country. 

Mr.  Nibecker,  House  of  Refuge,  Glen  Mills,  Pa.,  con- 
siders that  character  is  not  inherited,  but  that  the  environ- 
ment in  which  a  child  is  placed  determines  his  character 
almost  absolutely,  in  so  far  as  the  limitations  of  his 
physical  constitution  and  quality  allow  of  variation.  In 
an  investigation  involving  several  hundred  pupils,  it  ap- 
<  peared  that  the  only  ones  who  could  be  considered 
incorrigibles  were  deficient  in  brain  quality,  being  capa- 
ble of  receiving  instruction  to  a  certain  extent  and  of  a 
certain  kind,  and  then  coming  to  a  standstill:  yet  even 
of  these,  many  afterwards  lead  blameless  lives.  In 
the  forcing  surroundings  of  a  low,  degraded  life,  the 
children  surviving  are  precociously  developed  and  their 
characters  are  fixed  to  an  extraordinary  degree  at  an  age 


Appendix  169 

before  those  in  normal  conditions  of  life  begin  to  harden 
at  all  into  shape. 

Mr.  Chapin,  of  the  Lyman  School  for  Boys,  West- 
borough,  Mass.,  says  that  among  the  three  hundred  at 
that  time  in  the  school,  he  could  find  perhaps  twenty  who 
bore  the  evidence  of  heredity,  which  they  will  always  carry 
with  them,  and  it  is  very  doubtful  if  they  can  outgrow  it 
or  overcome  it.  He  inclines  to  believe  that  the  effects 
of  environment  are  nearly  as  difficult  to  change  after  the 
child  becomes  sixteen  or  seventeen  years  old  as  the  appar- 
ently permanent  effects  of  heredity:  habits  are  fixed,  and 
the  enormous  effort  of  will  and  fixed  purpose  requisite  to 
change  them  are  not  found  as  often  as  one  could  wish. 

Elizabeth  Kew,  of  the  Children's  Aid  Society,  Phila- 
delphia, states  that  the  experience  of  that  society  for 
sixteen  years  shows  that  children  from  the  ranks  of 
pauperism  and  crime,  if  taken  when  under  eleven  years 
of  age,  and  placed  in  carefully  selected  homes,  almost 
always  turn  out  well. 

Sarah  M.  Crawford,  State  Board  of  Charity,  Boston, 
speaks  of  children  placed  to  board,  one  or  two  in  a 
family,  in  suburban  towns.  Most  of  them  are  found- 
lings, or  infants  deserted  by  parents  of  bad  character. 
"  We  have  never  had  a  complaint  from  a  single  family 
where  a  little  girl  has  been  adopted,  and  I  can  recall 
but  three  or  four  boys  who  have  not  fulfilled  our  highest 
expectations." 

Lyman  P.  Alden,  of  the  Michigan  State  School  for 
Dependent  Children,  has  more  faith  in  the  power  of  en- 
vironment than  he  had  ten  years  ago,  but  its  transforming 
power  requires  time — usually  many  years. 

Mr.  Briggs,  of  the  Rochester  Industrial  School,  has 
had  numerous  boys  committed  to  the  school  who  had 


1 70  Sanity  of  Mind 

been  adopted  by  good  families  while  very  little,  and  had 
been  well-behaved  when  small,  but  became  uncontrol- 
lable at  the  age  of  puberty. 

III.    MASTURBATION 
(Page  76) 

Among  the  assigned  causes  of  insanity  the  practice  of 
self-abuse  is  often  mentioned.  The  subject  is  of  great 
importance  to  parents  and  those  engaged  in  educational 
or  reformatory  work;  but  it  is  so  involved  in  medical 
considerations  that  it  cannot  be  fairly  and  fully  discussed 
in  the  present  book.  Those  desirous  of  seeing  the  ques- 
tion treated  broadly  and  wisely  may  do  well  to  refer  to 
Dr.  T.  S.  Clouston's  classic  work,  Clinical  Lectures  on 
Mental  Diseases,  page  482.  The  Dictionary  of  Psychologi- 
cal Medicine  (1892),  by  J.  Batty  Tuke,  M.D.,  contains 
very  valuable  articles  on  Masturbation,  Sexual  Perver- 
sion, and  Sex  in  Insanity.  Clinical  Studies  in  Vice  and 
Insanity,  by  Geo.  R.  Wilson,  M.D.  (1899),  has  most 
interesting  discussions,  pages  150-157. 

IV.    STATISTICS  OF  THE  DEFECTIVE   CLASSES 
(Pages  83,  148) 

The  data  are  at  best  only  approximations.  It  is  per- 
fectly understood  that  census  returns  of  the  defective 
classes  are  far  below  the  probable  true  numbers,  at  least 
in  the  United  States.  As  regards  the  basis  of  the  esti- 
mates here  offered:  Insane  persons  are  reckoned  at 
somewhat  less  than  3  in  1000  of  the  population;  the  fee- 
ble-minded (imbeciles  and  idiots)  are  doubtless  as  num- 
erous (Dr.  Fernald  estimates  4  in  1000);  the  proportion 


Appendix  171 

of  epileptics  varies  considerably  in  different  European 
countries,  but  for  the  United  States  we  may  follow  Dr. 
Spratling  of  Craig  Colony,  who  considers  i  in  600  as  a 
conservative  estimate. 

As  to  the  "  backward  "  children,  the  recent  examina- 
tion of  100,000  school  children  in  England  discovered 
that  about  1.6  per  cent,  of  those  in  school  were  physically 
or  mentally  deficient  to  a  marked  extent,  so  as  to  profit 
little  by  ordinary  education,  and  to  require  special  classes 
in  order  to  give  them  a  reasonable  chance  of  becoming 
intelligent  citizens  and  to  relieve  the  asylum  schools 
(Charities  Review ',  April,  1900).  Philadelphia  reports 
1 1 22  children  as  too  backward  for  instruction  by  ordinary 
methods  in  large  classes,  besides  others  excused  from  at- 
tendance and  many  in  the  special  schools  for  truants  and 
incorrigibles, — in  all  about  one  per  cent.  The  Report 
of  the  United  States  Commissioner  of  Education,  1897-98, 
vol.  ii.,  p.  2509,  states  the  number  of  the  feeble-minded 
in  institutions  as  9232 ;  of  the  deaf,  10,878;  of  the  blind, 
3774.  The  census  returns  of  the  total  number  of  deaf 
and  dumb  were  40,592;  of  the  blind,  50,568. 


INDEX 


Accident  neuroses,  139 

Action  and  thought,  too 

Activity,  see  Occupation 

Adenoid  vegetations,  88 

Adolescence,  66 

Adolescent  insanity,  67,  68,  116 

Alcoholism,  see  Drunkenness, 
Intemperance 

Alden,  origin  of  character,  169 

Alt-Scherbitz,  149 

Anger,  123 

Artistic  temperament  and  neuro- 
sis, 72,  77 

Attention,  107  ;  weak  in  the  fee- 
ble-minded, 77 


Backward  children,  83,  171 

Beecher,  Catherine  E.,  health  of 
American  women,  71 

Beedy,  Mary  E.,  disregard  of 
health,  143 

Bielefeld,  155 

Birth,  58 

Blake,  deafness  in  school-chil- 
dren, 86 

Blandford,  statistics  of  insanity, 
67 

Border  -  line  insanities,  13  ;  in 
children,  89 

Breakdown  from  constitutional 
weakness,  91 

Briggs,  origin  of  character,  169 

Briquet,  hysteria,  64,  68 

Brockway,  antecedents  of  crimi- 
nals, 39 

Brooks,  Phillips,  sentimentalism, 
101 


Bunyan,  cure  of  his  mental  mal- 
ady, 130 

Burk,  child-study,  96 
Butler,  spontaneity,  4 

Call,  Miss,  repose,  in,  132 

Carlyle,  obedience,  in 

Carter,  defective  eyesight,  86 ; 
its  effect  on  character,  104 

Castration,  161 

Causation,  see  Degeneracy,  He- 
redity, Statistics,  etc. 

Cause  and  effect  confounded,  43 

Chapin,  John  B.,  asylum  statis- 
tics, 49 

Chapin,  T.  F.,  origin  of  charac- 
ter, 169 

Character  as  dependent  on  en- 
vironment or  heredity,  168 

Children's  diseases,  58 

Child-study,  54,  62,  90,  95 

Chorea,  61,  72 

Civilization  as  a  cause  of  insan- 
ity, 52 

Classes  in  school,  size  of,  85 

Cloplatt,  hysteria,  64 

Clouston,  heredity,  18  ;  stigmata 
in  idiocy,  36  ;  neurotic  tenden- 
cies in  children,  58  ;  hysteria, 
64,  68 ;  precocity,  68,  76 ;  reg- 
imen for  children,  76 

Cocaine,  46 

Colonies,  47,  155 

Concealment  of  insanity,  etc., 
prior  to  marriage,  164 

Convulsions,  60 

Cottage  asylums,  149 

Craig  Colony,  47,  155 


173 


174 


Index 


Crawford,  Sarah   M.,  origin   of 

character,  169 
Cretinism,  82,  83 
Criminals,  stigmata  in,  37;  made, 

not    born,    39 ;    insane,    41 ; 

short  stature,  70 
Custodial  care  of  defectives,  148, 

157 ;  see  Colonies 

Dale,  chorea,  61 

Deafness,  overlooked  in  school- 
children, 86  ;  from  adenoids,  88 

Degeneracy,  constitutional  ner- 
vous tendencies  in,  13  ;  bio- 
logical definition  of,  28  ;  inher- 
itable, 29  ;  defined  by  Nacke, 
32  ;  stigmata  of,  32,  34,  38  ;  in 
idiots,  36;  in  criminals,  39  ;  of 
later  life,  135  ;  as  a  social 
problem,  147 

Delirium,  59 

Dementia,  10 

Dementia  praecox,  12 

Depression,  see  Melancholia, 
Low  spirits,  Neurasthenia 

Detention  hospitals,  152 

Development  of  faculty,  55  ;  dis- 
orders of,  58  ;  in  the  feeble- 
minded, 69  ;  bodily  and  men- 
tal associated,  69 

Diet  for  neurotics,  73,  76,  121 

Disobedience,  112 

Disorders  akin  to  insanity,  25, 
32,  33,  44,  46 

Dreams,  59 

Drunkenness,  restraint  in,  164 

Dukes,  sleep,  73 

Dun-sur-Auron,  150 

Early  treatment  of  insanity,  151 
Echeverria,  alcoholism,  and  epi- 
lepsy, 44 

Education,  defined,  53,  55  ; 
based  on  a  study  of  develop- 
ment, 54 ;  and  of  neurotic 
tendencies  in  childhood,  58  ; 
of  the  body,  69 ;  of  neurotic 
children,  69,  73  ;  of  the  feeble- 


minded, 77  ;  of  the  backward, 
83  ;  favorable  to  mental  stabil- 
ity, 97  ;  in  hysteria,  103 

Egoism  of  insanity,  8,  115,  117, 
128 

Elmira  Reformatory,  39,  107 

Ennui,  132 

Epilepsy,  alcoholic,  44 ;  statis- 
tics of  causes,  47  ;  treatment 
in  colonies,  155 

Farmers'  wives,  126 

Far-sight,  66 

Fatigue,  mental,  90 

Feeble-minded,  physical  defects 
of  the,  36,  69  ;  bad  heredity, 
47  ;  mental  character,  77  ; 
training,  78 ;  religious  and 
affectional  nature,  81,  82  ; 
distinguished  from  the  back- 
ward, 84  ;  misunderstood,  87  ; 
•marriage  of,  156,  159,  164 ; 
women,  a  menace  to  society, 
157.  163 ;  in  colonies,  160 ; 
surgical  treatment  of,  161 

Fere,  stigmata,  33  ;  constitution- 
al causes  of  insanity,  46 

Fernald,  manual  education  for 
the  feeble-minded,  79  ;  moral 
imbecility,  8 1  ;  feeble-minded 
women,  158 

Feuchtersleben,  129 

Fixed  ideas,  n,  14 

Flechsig,  alcoholism,  45 

Flynt,  Josiah  (pseud.),  criminal 
traits,  40 

Food,  insufficient,  94,  122 ;  see 
Diet 

Franklin,  tranquillity,  no 

Genius,  52 
Gheel,  150 
Goitre,  82 
Griesinger,  individual  treatment 

of  insanity,  154 
Growth,  law  of,  54 
Guardian  societies  for  the  insane, 

154 


Index 


Gymnastic  training,  in  hysteria, 
65  ;  basis  of  education  for 
neurotics,  72  ;  for  the  feeble- 
minded, 79 

Hall,  anger,  120 

Hartwell,  stuttering,  63 

Heredity,  in  neurasthenia,  15  ; 
biological  definition  of,  1 8 ; 
considered  as  cause  of  insanity, 
19  ;  latent,  21  ;  absent,  22  ; 
interchangeable  or  dissimilar, 
25,  33,  44  ;  direct,  24  ;  wrong 
popular  views  of,  22,  26  ;  in 
epilepsy  and  feeble-minded- 
ness,  47 

Hurd,  inheritance,  21 ;  deten- 
tion hospitals,  152 

Hypochondria,  10 

Hysteria,  64  ;  related  to  insanity, 
68,  115 

Idiocy,  see  Feeble-minded 

Infancy,  59 

Inhibitory  power  in  children,  59 

Insanity,  definitions,  8  ;  respon- 
sibility in,  8,  130  ;  impulsive, 
9,  13  ;  classification,  9  ;  bor- 
der-line, 13,  89;  pathology, 
12,  16 ;  recovery  or  relapse, 
12,  22 ;  adolescent,  67,  68, 
116  ;  in  children,  58,  67,  68, 
74  ;  statistics  of  causes,  48,  67  ; 
occasional  causes,  41,  49  ;  cau- 
sal relations  or  associations 
with  certain  neuroses,  33  ;  with 
certain  diatheses,  46 ;  with 
hysteria,  68  ;  with  neurasthe- 
nia, 15,  138  ;  with  crime,  41  ; 
with  intemperance,  42,  50 ; 
with  traumatism,  45  ;  with 
civilization,  51  ;  basal  tenden- 
cies in,  117  ;  egoism  in,  see 
Egoism  ;  prevention  by  educa- 
tion, 97  ;  by  moral  agencies, 
124,  125  ;  Bunyan's  case,  130  ; 
retiring  from  business,  133  ; 


early  treatment,  151  ;  individ- 
ual treatment,  154;  after-care, 
155 ;  in  relation  to  certain 
marriages,  24,  163 

Instability,  of  nerve-tissue,  25  ; 
mental  and  nervous,  30  ;  re- 
lation to  degeneracy,  31 

Intemperance,  42,  50;  see  Drunk- 
enness 

Introspection,  104,  129 

Ireland,  feeble-mindedness,  81, 
82,  87,  159 

Irritable  weakness,  74 

Italian  school  of  anthropology, 
37,  39 

Jacobi,  Mary  Putnam,  insane 
predisposition  analyzed,  117 

Johnson,  Mrs.,  disobedience, 
112 

Keen,  castration,  161 

Kerlin,  moral  imbecility,  80 ; 
danger  from  feeble-minded 
women,  158 

Kew,  Elizabeth,  origin  of  char- 
acter, 169 

Key  and  Hertel,  school  diseases, 

93 

Kindergarten,  no 

Kindred  affections  to  insanity, 
see  Disorders 

Koch,  minderwertigkeit,  73 

Kraepelin,  forms  of  insanity,  II ; 
mental  fatigue,  90 

Krafft-Ebing,  recurrence  of  in- 
sanity, 23  ;  individual  treat- 
ment, 154 

Landouzy,  hysteria,  64 
Law  of  growth,  55 
Letchworth,  epileptics,  155 
Lierneux,  150 
Lloyd,  hysteria,  103 
Lombroso,  stigmata  of  degene- 
racy, 37 
Low-spirits,  136 


76 


Index 


MacDonald,  criminal  anthro- 
pology, 37 

Macpherson,  causes  of  insanity, 
42 

Mania,  10 

Manic-depressive  insanity,  II 

Manual  training,  for  the  feeble- 
minded, 79 ;  for  developing 
self-control,  108 

Marriage,  of  relatives,  24 ;  of 
feeble-minded,  156;  restric- 
tions on,  163 

Masturbation,  170 

Materialism,  3-6 

Maudsley,  definition  of  insanity, 
8  ;  traumatic  insanity,  45 

McLean  Asylum,  152 

Melancholia,  10,  136 

Memory,  105 

Mental  therapeutics,    124,    139, 

152-154 

Mercier,  definition  of  insanity, 
8  ;  responsibility,  9 ;  proba- 
bility of  recurrence,  26  ;  hys- 
teria, 115  ;  retiring  from  busi- 
ness, 133 

Middle  life,  insanity  of,  133 

Mills,  morbid  fears,  89 

Minderwertigkeit,  73 

Moral  agencies  in  insanity,  124, 
see  Mental. 

Moral  imbecility,  79 

Morel,  socie'te's  de  patronage,  154 

Morrison,  insanity  in  prisons, 
41 

Myxcedematous  idiocy,  83 

Nacke,  degeneration  defined,  32; 

stigmata,  38 
Near-sight,  65  ;   misunderstood, 

86  ;  effect  on  character,  104 
Nervousness,  121 
Neurasthenia,  15,  137 
Neuropathic  family  of  disorders, 

32,  44 

Neuroses  of  development,  58 
Neurotic  children,  diet  and  regi- 
men, 69,  72,  76 


Nibecker,  formation  of  charac- 
ter, 168 

Night-terrors,  59 

Nutrition  of  brain  impaired,  in 
insanity,  17  ;  by  poor  diet,  94, 

122 

Obedience,  109-111 
Observation,  104 
Occupation,  128-136 
Opium,  46,  50 
Orderliness,  77 
Ovariotomy,  163 
Over-study,   89-93  ;   a  cause  of 
chorea,  61 

Paranoia,  II 

Parental  influence  for  evil,  4, 
72,  H5 

Paresis,  10 

Peterson,  psychopathic  hospi- 
tals, 151 

Phobias,  14 

Physical  training,  see  Gymnas- 
tics ;  should  be  equalized  with 
other  studies  in  college,  142 

Play,  71,  93 

Precocity,  68,  72,  74 

Psychopathic  hospitals,  151 

Puberty,  66 

Putnam,  suggestion  as  a  cause 
of  disease,  139 

Regimen  for  neurotic  child,  69, 

72,  76 

Religious  feelings,  62 
Responsibility  in  insanity,  9,  124 
Retirement  from  business,  133 
Rickets,  60 

Riis,  causes  of  intemperance,  43 
Romantic  solitude,  128 
Royce  on  Bunyan's  case,  130 

Sanborn,  statistics,  146,  149 
School   authorities,  responsibili- 
ties of,  75 

School  programme,  and  lunches, 
9°,  94 


Index 


177 


Scotland,  care  of  insane  in,  150 

Self-absorption,  116,  117,  128 ; 
ef.  Egoism 

Self-activity,  4,  100 

Self-control,  5,  108,  119,  124 

Selfishness,  113,  see  Egoism,  Self- 
absorption 

Self-support  of  feeble-minded, 
160 

Self-torment,  128 

Senescence,  141 

Sentimentalism,  xoi 

Sex,  in  chorea,  61 ;  in  stuttering, 
64  ;  in  hysteria,  64  ;  precocity 
in,  74  ;  abuses,  76 

Sight,  defects  of,  see  Near-sight, 
Far-sight 

Size  of  body,  69 

Sloyd,  108 

Smith,  early  care  of  insanity, 
152 

Soci&/s  de  patronage,  154 

Society  a  mental  need,  126 

Standish,  defects  of  sight,  66 

Statistics,  of  causation  of  insani- 
ty, 47  ;  of  the  defective  classes, 
145,  170  ;  of  growth  of  chil- 
dren, 56  ;  of  hysteria,  64 ;  of 
insanity  in  children,  67 

Stearns,  disobedience,  112 

Stewart,  statistics  of  causes,  49 

Stigmata  of  degeneration,  32  ; 
significance,  32,  34,  38  ;  com- 
mon to  all  forms,  34 ;  fre- 
quency, 37 

Stimulants,  73,  76,  123 


Sturgis,  chorea,  61 
Stuttering,  63 

St.  Vitus'  Dance,  see  Chorea 
Suggestion-treatment,  138 
Suicide  in  children,  74 

Training,  see  Manual,  Gymnas- 
tics 

Tranquillity,  no 

Trtiper,  minderwertigkeit,  73 

Tuke,  diagnosis  of  feeble-mind- 
edness,  84  ;  civilization  related 
to  insanity,  51  ;  intemperance 
a  cause  of  insanity,  45  ;  over- 
work in  schools,  91 

Ueberbur dungs f rage  i  93 
Unsocial  nature  of  insanity,  8, 

see  Egoism 

Unused  faculty  a  source  of  dis- 
ease, 130 

Village  care  of  the  insane,  149 
Vital  index,  72 

Warner,     mental     hygiene     in 

schools,     63  ;     hysteria,    64 ; 

child-study,  97  ;  introspection, 

104 

Weismannian  theory,  29 
Will,  2,  3,  100,  107,  117 
Wilson,  G.  R.,  moral  treatment 

of  insanity,  125 
Wilson,  L.  N.,  child-study,  96 
Wyckoff,  ennui,  132 


UNIVERSITY  OF  CALIFORNIA  AT  LOS  ANGELES 
THE  UNIVERSITY  LIBRARY 


This  book  is  DUE  on  the  last  date  stamped  below 


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